Cases of isolated duodenal stenosis in the neonatal period are minimally reported in pediatric literature. Causes of small bowel obstruction such as duodenal atresia or malrotation with midgut volvulus have been well documented and are often diagnosed due to their acute clinical presentation. Duodenal stenosis, however, causes an incomplete intestinal obstruction with a more indolent and varying clinical presentation thus making it a diagnostic challenge. We present a neonate with a unique case of congenital duodenal stenosis. The neonate presented with poor weight gain and frequent "spit-ups" as per the mother at the initial newborn visit. The clinical presentation was masked as the patient was being fed infrequently and with concentrated formula. We postulate that this may be due to the fact that the mother was an adolescent and relatively inexperienced with newborn care. During the hospital course, the patient had recurrent episodes of emesis with notable electrolyte abnormalities including hypochloremia and metabolic alkalosis. Further investigation with an abdominal X-ray showed dilated loops of bowel. Pyloric stenosis was ruled out via abdominal ultrasound. An upper gastrointestinal (GI) series ultimately confirmed a diagnosis of duodenal stenosis and the infant underwent surgical repair with full recovery. Congenital duodenal stenosis may have atypical presentations in neonates requiring pediatricians to have a high index of suspicion for diagnosis and to ensure timely therapy.

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Cutaneous myiasis is a condition that involves an infestation of fly larvae into human tissue, most commonly caused by Dermatobia (D.) hominis or the bot fly. While this is a condition most commonly seen in tropical regions of the globe due to increased travel to endemic regions, physicians must increasingly be aware of this as a potential diagnosis. In addition, there is minimal literature on cutaneous myiasis in the pediatric patient and its potential associated symptoms. This case report thus highlights a toddler that presented to our facility with a raised, erythematous scalp lesion and associated preauricular and occipital lymphadenopathy. Of note, the patient had a recent travel history to Belize, an endemic area where she was likely infected. As there are multiple other differentials for not only scalp swellings in the pediatric population, in addition to regional adenopathy, a high index of suspicion was needed to make the diagnosis. Ultrasound was the imaging modality used to visualize the fly larva, and surgical excision was the mechanism of treatment. Thus, this case highlights a unique presentation of cutaneous myiasis in a toddler and aims to add to the growing body of literature on a condition likely to be encountered by physicians at a greater frequency.