Definition and Overview

Duodenum is the first section of the intestine that is responsible for absorbing nutrients from partially digested food it receives from the stomach. It also plays a crucial role in the chemical digestion of food using digestive enzymes released by the pancreas, gallbladder, and liver.

The duodenum can be obstructed due to tissue damage, peptic ulcers, birth defects, or benign or malignant growths. The condition results in:

  • Accumulation of food, gas, and gastric juices above the point of obstruction

  • Bacterial growth in the stomach

  • Dehydration

  • Poor digestion and nutrition

  • Fluid and electrolytes imbalance

  • Infection and inflammation of the abdomen’s lining (peritonitis)

Causes of Condition

Obstruction of the duodenum can occur in adults and infants. In adults, the common cause is repeated injury and scarring of the duodenum due to chronic peptic ulcers. A peptic ulcer is a sore that develops in the lining of the small intestine, lower oesophagus, and stomach due to stomach acids and H. pylori bacteria. However, advancements in the medical treatment of peptic ulcers have significantly reduced the incidence of such complication. .

Other causes of the condition are:

  • Gallstones

  • Ingestion of foreign objects

  • Infection or inflammation caused by certain conditions, including Crohn’s disease and diverticulitis

  • Benign or malignant growths

In infants, the condition is commonly caused by congenital anomalies that result in duodenal stenosis (narrowing of the duodenum), underdeveloped duodenal channel (duodenal hypoplasia), and malformed duodenal lumen (duodenal atresia). Obstruction of the duodenum can also occur due to duodenal malrotation or if the duodenum twists around itself (volvulus).

Key Symptoms

Symptoms of an obstructed duodenum are the following:

  • Vomiting - This is the classic sign of an obstructed duodenum. As the food and gastric juices are unable to pass through the duodenum, they normally build up on the site of the obstruction and reflux back into the stomach. The vomit is often green in colour due to the presence of bile.

  • Abdominal pain - Often described as intermittent pain that can worsen if the condition progresses to strangulation

  • Nausea

  • Abdominal distention - When undigested food accumulates in the duodenum, the walls of the small bowel are stretched, causing them to press on surrounding tissue.

  • Indigestion

  • Feeding difficulties and vomiting within hours of birth (in infants)

  • Bowel palpitations - When the duodenum is obstructed, the muscles of the bowel walls will contract to force solid and liquids through the intestine. Due to the obstruction, this results in very rapid peristaltic contractions or palpitations within the bowels.

  • Changes in bowel habits

  • Constipation

Who to See and Types of Treatments Available

An obstructed duodenum shares the same symptoms with other conditions that affect the gastrointestinal tract. To make a diagnosis and rule out other possible diseases and disorders, the following tests and procedures are commonly performed:

  • Abdominal x-ray, which can show if the duodenum is dilated

  • Chest x-ray and echocardiogram - If the patient is an infant, these tests are also ordered to check for other congenital abnormalities and cardiac defects.

  • Complete blood count (CBC)

  • Contrast-enhanced x-ray, which is ordered if volvulus is suspected

  • Electrolytes, blood urea nitrogen, and other blood chemistries

  • Kidney and pancreas function tests

  • Ultrasound

  • Urinalysis

Treatment

Infant patients immediately receive treatment for the complications of their condition. Their stomach and duodenum are decompressed to prevent food material from accumulating in the duodenum and are given intravenous fluids to prevent dehydration and restore electrolyte balance.

The definitive treatment for duodenum obstruction is a surgical procedure called duodenoduodenostomy. It is performed under general anaesthesia and requires either a long incision in the abdomen or small cuts (laparoscopic method) to access the duodenum. The surgeon will then open the duodenum channel and correct the duodenal lumen end to end.

Despite improvements in techniques used in surgery, as many as 22% of children who undergo the procedure suffer from late complications, which include:

  • Blind-loop syndrome

  • Altered duodenal motility

  • Gastritis

  • Oesophagitis

  • Gastroesophageal reflux

  • Pancreatitis

  • Cholecystitis

For this reason, patients are scheduled for annual follow-up appointments, which help doctors catch early signs of complications so they can be treated or managed before they worsen.

References:

  • Alatas FS, Masumoto K, Esumi G, Nagata K, Taguchi T. Significance of abnormalities in systems proximal and distal to the obstructed site of duodenal atresia. J Pediatr Gastroenterol Nutr. 2012 Feb. 54(2):242-7

  • Redel, Carol A., and R. Jeff Zeiwner. “Anatomy and Anomalies of the Stomach and Duodenum.” In Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, edited by Mark Feldman, et al. Philadelphia: W. B. Saunders Co., 1997.

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