Pediatr Gastroenterol Hepatol Nutr.  2013 Mar;16(1):49-52. 10.5223/pghn.2013.16.1.49.

Congenital Antral Web in Premature Baby

• Nam SH
• Koo SH
• Chung ML
• Jung YJ
• Lim YJ

• KMID: 1428807
• DOI: http://doi.org/10.5223/pghn.2013.16.1.49

Abstract

Antral web is a rare cause of gastric outlet obstruction in neonate. It is a 2-4 mm thin mucous membrane that can be found anywhere from 1 to 7 cm proximal to the pylorus. The baby was born at gestational age of 32(+1) weeks with 1,880 g as 2nd baby of dizygotic twin. After birth, the baby had constant non-bilious vomiting without feeding while he didn't show abdominal distension or discoloration. The infantogram showed distended stomach with distal small bowel gas. Upper gastrointestinal series revealed that the antrum was abruptly narrowed at 1 cm proximal to pylorus. We performed laparotomy at the 10th day after birth and excised the 2 mm-thick web circumferentially. He began milk feeding after 6 days and discharged uneventfully at postoperative 35 days with corrected age of 38(+4) weeks with body weight 2,420 g. The antral web should be considered in the case of non-bilious vomiting in neonate.

Keyword

Gastric outlet obstruction; Antrum; Web; Vomiting

MeSH Terms

Body Weight
Carbamates
Gastric Outlet Obstruction
Gestational Age
Humans
Infant, Newborn
Laparotomy
Milk
Mucous Membrane
Organometallic Compounds
Parturition
Pylorus
Stomach
Twins, Dizygotic
Vomiting
Carbamates
Organometallic Compounds

Figure

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  Fig. 1 Upper gastrointestinal series showed distended stomach with linear defect in antrum from 1 cm proximal to pylorus.

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  Fig. 2 The stomach was severely distended and the antrum was hypertrophied. After gastrotomy, 2 mm-thick web was found near pylorus.

Reference

1. Hait G, Esselstyn CB Jr, Rankin GB. Prepyloric mucosal diaphragm (antral web): report of a case and review of the literature. Arch Surg. 1972. 105:486–490.

2. Nissan A, Seror D, Udassin R. Gastric outlet obstruction caused by prepyloric mucosal diaphragm mimicking duodenal ulcer: a case report. Acta Paediatr. 1997. 86:116–118.

3. Gerber BC. Prepyloric diaphragm, an unusual abnormality. A case report. Arch Surg. 1965. 90:472–480.

4. Lui KW, Wong HF, Wan YL, Hung CF, Ng KK, Tseng JH. Antral web--a rare cause of vomiting in children. Pediatr Surg Int. 2000. 16:424–425.

5. Bell MJ, Ternberg JL, McAlister W, Keating JP, Tedesco FJ. Antral diaphragm--a cause of gastric outlet obstruction in infants and children. J Pediatr. 1977. 90:196–202.

6. Berr F, Rienmueller R, Sauerbruch T. Successful endoscopic transection of a partially obstructing antral diaphragm. Gastroenterology. 1985. 89:1147–1151.

7. Jung SE, Yu CS, Lee SC, Park KW, Kim WK. The surgical treatment for congenital gastric outlet obstruction. J Korean Surg Soc. 1993. 44:382–385.

8. Jung J, Moon KR. A case of an antral web with a gastric ulcer due to ibuprofen. Korean J Pediatr Gastroenterol Nutr. 2010. 13:66–69.

9. Choi KJ. Prepyloric gastric antral webs in children-report of two cases and review of the literature. J Korean Surg Soc. 1988. 35:610–614.

10. Blazek FD, Boeckman CR. Prepyloric antral diaphragm: delays in treatment. J Pediatr Surg. 1987. 22:948–949.

11. Tiao MM, Ko SF, Hsieh CS, Ng SH, Liang CD, Sheen-Chen SM, et al. Antral web associated with distal antral hypertrophy and prepyloric stenosis mimicking hypertrophic pyloric stenosis. World J Gastroenterol. 2005. 11:609–611.

12. Anthony JP, Barbara JS. Kliegman RM, Behrman RE, editors. Digestive system disorders. Nelson textbook of pediatrics. 2007. 18th ed. Philadelphia: Elsevier Saunders;753.

13. Medsinge A, Bartoletti SC, Furtado A, Katz A, Tadros SS. Isolated intramuscular fibrous band masquerading antral web in a premature neonate. A case report. J Pediatr Surg. 2012. 47:e17–e19.