In the eighth to tenth week of development, the solid duodenum recanalizes to result in the typically hollow cylinder that characterizes older intestine. On occasion, however, successful recanalization is thwarted and intestinal atresia, stenosis, or membranous web results. The former two most often manifest early in childhood with Gl obstruction, whereas the last has a more variable time frame and manner of presentation. Because of the prograde movement of intestinal contents, the web may become stretched, forming an intraluminal diverticulum; the aperture of the original web usually remains near its initial position and allows variable amounts of intestinal secretions and ingested substances to pass through it into the intestinal lumen, now narrowed by the diverticulum. The appearance of the diverticulum has been likened in the medical literature to a windsock, which is used to judge the direction and magnitude of wind, usually in rural settings. To those of us who live in urban settings, this windsock diverticulum looks more like an unrolled condom, and, to some, also bears semblance to a bariatric sleeve. Of course, to those of us in urban settings, an actual ingested condom—still with rolled edges—tells us the person who harbors it is a mule, or drug trafficker. Duodenal membranes and windsock deformities are associated with other anomalies, such as intestinal malrotation and preduodenal portal vein; the latter is of importance to the operating surgeon. Pancreatitis may be caused by the associated anomaly such as pancreas divisum or by ampullary obstruction or distortion by a windsock that is filled or obstructed by accumulated intestinal material. Windsock deformity is diagnosed classically by barium meal, the barium being retained in the sock for longer than 6 hours; in this case, EUS was diagnostic. Khalil Gibran said, "If you reveal your secrets to the wind, you should not blame the wind for revealing them to the trees." This patient went 23 years before...
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