Duodenal Duplication

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Abstract
The embryology, symptomatology, radiology, and surgical treatment of duodenal duplication have been discussed. Fifty-four cases from the literature were reviewed, and a new case diagnosed preoperatively. Complete obstruction with gastric distention and absence of gas in the gut distal to the lesion may be observed on abdominal roentgenograms. When the duodenal duplication does not communicate with the intestine, only an abnormal contour or the uniform density of a mass may be seen. Hope believes that if a single supine radiograph of the abdomen fails to show obstruction, introduction of a catheter and aspiration of the upper gastrointestinal tract with air replacement may make the diagnosis of high obstruction. If intestinal obstruction is present but the site is not determined, barium enema X-ray should be done and if no obstruction is then demonstrated, a gastrointestinal X-ray study using barium should be performed. Obstruction caused by narrowing of the duodenal lumen, together with displacement superiorly and laterally, may be noted. The duodenal loop may be widened. The duodenal bulb may be dilated or it may be crescent-shaped due to the mass indenting the inferior surface of this segment. Caffey reports that conclusive radiologic diagnosis can be made in rare instances when the roughened mucosal relief of ectopic rugae are seen in the duplication; roentgen findings may be normal if the duplication is large. The barium X-ray study in adults may show an oval filling defect or a well defined marginal defect in the concavity of the first and second portions of the duodenum.