Duodenal obstruction in an infant a rare presentation

Author : Brig (Dr) S.M. Sharma, Dr. M.S. Chahal, Dr. Sujoy Mukherjee, Dr Arjun Agarwal

A four and half month old female baby was admitted in our hospital with history of curdy white vomits and fever of seven days duration after normal delivery in a hospital . The parents of the infant observed peristaltic movements from left to right two months after delivery. The baby was kept on breast feeds which was followed by vomiting after each feed, the baby started having forceful projectile vomits after two months resulting in dehydration and passage of small hard stools. Clinical examination revealed an emaciated baby with tachycardia (HR 150/mt), good cry and no evidence of visible peristalsis after feeds. No lump could be palpated in epigastrium. CT abdomen was suggestive of duodenal stenosis resulting in dilatation of stomach. Gastrograffin studies revealed hugely dilated stomach and first part of duodenum. Exploration revealed a hugely dilated stomach and first part of duodenum which was compressed by an extra luminal tight thick band extending from pancreas to porta hepatis. Underneath this thick band intraluminal obstruction of first part of duodenum was found due to severe stenosis and obliteration by a diaphragm. Baby underwent duodeno-duodenal anastomosis after excision of extra luminal obstructing band with uneventful and exceptionally excellent post-operative recovery.

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