RARE DELAYED PRESENTATION OF DUODENAL ATRESIA WITH ANNULAR PANCREAS: A CASE REPORT

Abstract

Background: Duodenal atresia is a congenital gastrointestinal obstruction caused by failure of fetal duodenal recanalization. Although it commonly presents in the neonatal period with bilious vomiting, atypical delayed presentations are increasingly recognized, particularly in Type 1 atresia (duodenal web).

Case Presentation: We describe an 11-month-old infant with a 6-month history of recurrent non-bilious vomiting, intolerance to solids, and failure to thrive. Imaging suggested proximal duodenal obstruction, while intraoperative findings revealed Type 1 duodenal atresia due to a duodenal web, compounded by annular pancreas. Surgical correction was achieved via Kimura’s diamond-shaped duodenoduodenostomy.

Outcome: The infant had an uneventful recovery, with resolution of vomiting, tolerance of regular diet, and significant catch-up growth.

Conclusion: This case highlights the importance of maintaining suspicion for congenital duodenal obstruction beyond the neonatal period. Annular pancreas in conjunction with a duodenal web adds diagnostic and operative complexity, but timely recognition and Kimura’s duodenoduodenostomy provide excellent outcomes.