Congenital pyloric web: A rare cause of neonatal gastric outlet obstruction

Abstract

Congenital gastric outlet obstruction is a rare clinical entity. It may be confused with more common conditions (like idiopathic hypertrophic pyloric stenosis and others) and is difficult to diagnose. Patients have a dilated stomach with intermittent intolerance to feeds and have normal meconium and stool passage. Here is reported a case of a 10-day-old girl with recurrent non-bilious vomiting and upper abdominal distension after feeds. X-rays showed distended stomach with distal gas. On further investigation the baby was found to have a web in the pylorus. The web was excised via a prepyloric gastrotomy and reconstruction with a Heineke-Mikulicz pyloroplasty was done. Postoperative period was uneventful. On follow-up, the baby is asymptomatic and is thriving well. To conclude, presence of a pyloric web should be considered in neonates with non-bilious vomiting with a normal pylorus and a persistently distended stomach.

Keywords

• pyloric web
• neonatal gastric outlet obstruction
• pyloric atresia
• web
• type 1 pyloric atresia
• non-bilious vomiting