Extrinsic duodenal obstruction by congenital bands in an adult patient.

A 64 year old car production supervisor, presented in out-patients with a six month history of episodic vomiting, distension, and weight loss of 2 stones. There was no relevant past history. Physical examination was unremarkable but his barium meal showed considerable gastric stasis, and an obstruction at the third part of the duodenum as well as malrotation of the intestines (Figure 1). At laparotomy, the stomach and first two parts of the duodenum were massively dilated, but the third part was obstructed by strong fibrous bands which crossed it anteriorly, tethering the right colon to the posterior abdominal wall the bands of Ladd. There was a high mobile midline caecum, the large bowel was entirely on the left side of the abdomen, and the small intestine on the right side. There was no evidence of volvulus. Simple division of the bands was performed following which the patient made an uneventful recovery. A subsequent barium meal showed malrotation was still present, but there was now no evidence of intestinal obstruction (Figure 2). Discussion