Duodenal web associated with malrotation and review of literature

Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1: 500 and the symptomatic incidence is 1: 6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1: 10 000-1: 40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful.