An Adult Case of Windsock Web of the Duodenum Associated with Annular Pancreas and Malrotation of Intestine

Sadahiro Yoshida, Akiyasu Nakata, Tsuneo Saitoh, Michiaki Imatomi, Hiroko Nakamura

Departmentof Surgery, Oe Kyohdoh Hospital

Windsock web of the duodenum (funnel-type intraluminal duodenal diverticulum) is a rare congenital malformation; only 11 adult cases of windsock web have been reported previously in the Japanese literature. The case of a 47-year-old woman who had been complaining of epigastralgia and a sense of upper abdominal fullness for several years is referred to the hospital. Gastrointestinal X-ray series revealed post-bulbar duodenal stenosis, a barium-filled pear-shaped sac with radiolucent halo in the descending limb of the duodenum, gastric ulcer and malrotation of the duodenum and colon. Endoscopic observation showed that the duodenal web was attached to the entire circumference of the lumen and a small aperture was present. Surgical exploration was done under the diagnosis of windsock web of the duodenum. Duodenotomy showed the complete annular pancreas with stenosis in the upper part of the descending limb of the duodenum and the windsock web with a small aperture, but the papilla of Vater could not be recognized. Therefore, conventional distal gastrectomy with Billroth-II reconstruction and duodeno-duodenostomy were performed. The postoperative course was uneventful. She was discharged symptom- free on the 23rd postoperative day.

Key words
windsock web of the duodenum, intraluminal duodenal diverticulum, annular pancreas

Reprint requests
Sadahiro Yoshida Departmentof Surgery, Oe Kyohdoh Hospital
252 Kamojima, Kamojima-cho, Oe, Tokushima, 776 JAPAN

Accepted
June 14, 1993

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