A rare case of esophageal atresia with gastric outlet obstruction

Abstract

Although the combination of gastric outlet obstruction and esophageal atresia is rarely seen in neonates, it has been well described. We report the case of a 5-day-old newborn with esophageal atresia and tracheoesophageal fistula associated with complete gastric outlet obstruction due to a mucous plug. As the patient had intense gastric distention, severe respiratory distress requiring ventilatory therapy and complete pyloric obstruction in radiograms, emergency gastrostomy was performed before definitive operation. Definitive treatment consisted of tracheoesophageal fistula ligation and primary esophageal anastomosis. Exploratory laparotomy during the same session revealed a normal pyloric canal, completely obstructed by a firm mucous plug. The plug was removed by pylorotomy, and a pyloroplasty was performed to ease gastric evacuation. Postoperative feeding problems suggested gastric dysmotility as the possible cause for the mucous plug obstruction.

Sonographic Appearance of an Antral Mass in an Infant

“…1,2 A mass causing gastric outlet obstruction is rare in infants. 1,3,4 Uncommon types of masses include ectopic pancreas, 3,[5][6][7][8][9] an intussuscepted polyp or hamartoma, 3 a plasma cell granuloma, 10 hypertrophied pyloric mucosa, 10 double juxtapyloric cyst with an ulcer, 10 pyloroduodenal duplication cysts, 11,12 focal foveolar hyperplasia, 7,13 hypertrophied antralpyloric fold, 14,15 mucous plug, 16 antral mucosal membrane/diaphragm, [17][18][19] lactobezoars, 20 gastric teratoma, 21 adenocarcinoma, 1 smooth-muscle neoplasms, 1 lymphoma, 1 gastric lipoma, 22 and vascular neoplasms. 1 Causes of vomiting that may mimic gastric outlet obstruction include pylorospasm, hiatal hernia, preampullary duodenal stenosis, 23 gallstones, 24,25…”