PITFALLS IN SURGICAL MANAGEMENT OF INCOMPLETE DUODENAL DIAPHRAGM

Twenty-one consecutive patients with incomplete duodenal diaphragms were treated without fatality. Observed and reported pitfalls for the surgeon include difficulty in diagnosis before and during laparotomy, coexistence with intestinal malrotation or intrinsic obstructions of the duodenum, stomach or anorectum, intimate anatomic relationship with the bile ducts, the confusing features of the windsock type diaphragm, and a tendency for malfunction of bypassing lateral anastomoses. Successful management has featured increased preoperative diagnostic effort, use of a Foley bag catheter or appropriate instrument to help locate and calibrate intrinsic obstructions, and a preference for excision of the diaphragm with protection of the bile ducts. © 1969.