title: Endoscopic Division of Duodenal Web Causing Near Obstruction in 2-Year-Old with Trisomy 21.
abstract: BACKGROUND
  Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported as successful in patients as young as 7 days of age, and can be a useful modality particularly in patients with comorbidities who may not tolerate open or laparoscopic surgery.
  
  
  METHODS
  A 2-year-old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as seen on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife and 15 mm radially dilating balloon.
  
  
  RESULTS
  The patient tolerated the procedure well, and also tolerated full age-appropriate diet by time of discharge on postoperative day 2. She remains asymptomatic as of 6 months postoperatively.
  
  
  CONCLUSIONS
  This report describes a successful endoscopic approach for definitive treatment of a duodenal web in a 2-year-old girl with trisomy 21, and laparoscopy confirmed no intraabdominal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and suggests an improved method of duodenal web division over pure surgical intervention.
authors.affiliation: Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California.
authors.forename: Lauren S Y
authors.initials: LS
authors.lastname: Wood
authors.affiliation: Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kastenberg
authors.affiliation: Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Sinclair
authors.affiliation: Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chao
authors.affiliation: Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California.
authors.forename: James K
authors.initials: JK
authors.lastname: Wall
mesh_terms: D000714:Anastomosis, Surgical; D002675:Child, Preschool; D004314:Down Syndrome / Q000175:diagnosis*; D004380:Duodenal Obstruction / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004386:Duodenum / Q000601:surgery; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007409:Intestinal Atresia; D010535:Laparoscopy / Q000379:methods*; D011184:Postoperative Period; D013270:Stomach / Q000601:surgery