Differential diagnosis of pediatric duodenal obstruction

• Intrinsic causes
  — Duodenal atresia
  — Duodenal stenosis
  — Duodenal web
• Extrinsic causes
  — Annular pancreas
  — Preduodenal portal vein
  — Malrotation with midgut volvulus
  — Duodenal hematoma
  — Superior mesenteric artery syndrome

Approach to the differential diagnosis of duodenal obstruction:

• In the neonate, consider
  Intrinsic causes – duodenal atresia via AXR and duodenal stenosis / duodenal web via upper GI
  Extrinsic causes – annular pancreas / preduodenal portal vein via US and malrotation with midgut volvulus via upper GI
• In the patient with bilious vomiting consider malrotation with midgut volvulus via upper GI
• In the patient with trauma consider duodenal hematoma via upper GI or US
• In the patient with recent weight loss or who is post surgery for scoliosis correction consider superior mesenteric artery syndrome via upper GI