Gastric emphysema in a child with congenital duodenal diaphragm

Álvarez, Carlos Forcadell; Vicente, J.; Fraile, Eduardo Miguel González

doi:10.1007/s002470050270

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…It has been found to be associated with necrotizing enterocolitis, concomitant with pneumatosis intestinalis and hepatobiliary gas as detected by abdominal X-ray 6,7. The other reported associations include pyloric stenosis,1,8,9,10 duodenal obstruction,11,12,13 and annular pancreas 14. It has also been reported in a premature infant developing gastric pneumatosis secondary to the placement of an intramural feeding catheter 15.…”

Section: Discussionmentioning

confidence: 97%

Gastric Pneumatosis in a Premature Neonate

et al. 2011

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Gastric pneumatosis is extremely rare during infancy. It has been reported in association with necrotizing enterocolitis or congenital abnormalities such as pyloric stenosis. Here, we report a case of gastric pneumatosis in a premature neonate on synchronized nasal intermittent positive pressure ventilation. No pneumatosis was noted in the rest of the bowel or esophagus. There could have been mild damage in the gastric mucosa, either related to the placement of the feeding tube or secondary to the use of indomethacin or both. The condition was further aggravated by noninvasive ventilation. An increase in intragastric pressure resulted in the submucosal dissection of air followed by the development of gastric pneumatosis. Conservative management strategies, including the use of a nasogastric tube for decompression and the withholding of feeding, successfully managed the gastric pneumatosis in our patient. An uneventful recovery was made after conservative management. Prompt recognition and evaluation of this condition were essential for making the diagnosis.

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Section: Discussionmentioning

confidence: 97%

Gastric Pneumatosis in a Premature Neonate

et al. 2011

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“…Gastric pneumatosis is an extremely rare condition and a primarily radiological diagnosis. In infancy, it has been associated with pyloric stenosis 8 , duodenal obstruction 9 , annular pancreas 10 , use of indomethacin with non-invasive respiratory support 11 , jejunal atresia 12 and necrotizing enterocolitis 13 ; in the latter setting, it has been attributed to widespread and severe disease requiring urgent surgical intervention 14 . It may also be secondary to intramural misplacement of a feeding catheter 15 .…”

Section: Discussionmentioning

confidence: 99%

Gastric Pneumatosis in a Preterm Infant: a Case Report and Review of Literature

Bonitatibus

Paterlini

Zanzucchi

et al. 2022

Preprint

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Background: gastric pneumatosis is a rare sign with a primarily radiological diagnosis. In newborn infants, this finding should raise the suspicion of necrotizing enterocolitis, which represents a serious clinical condition with high morbidity and mortality. However, other causes of gastric pneumatosis are reported in literature, including intramural displacement of a feeding tube. In this report we present a case of gastric pneumatosis in a preterm boy admitted to our NICU. Case presentation: the baby appeared pale and poor responsive during the first days of life on positive pressure ventilation and gavage feeding. A distended upper abdomen with bloody and biliary gastric aspirates was noted; no bloody stools were reported. Blood cultures, cerebrospinal fluid culture and blood cell count were normal; acute phase proteins were negative on serial determinations. Abdominal X-Ray showed gastric pneumatosis with displacement of the feeding tube and no other pathological findings in the rest of the bowel. After few days of conservative management, the baby improved dramatically. Conclusions: we suggest that the cause of this clinical picture could have been a mechanical lesion in gastric mucosa caused by the feeding tube; positive pressure ventilation then could have raised intragastric pressure, leading air to diffuse between the layers of the gastric wall.

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“…In our patient, the windsock deformity of the web was noted in the contrast study as well as during the surgery. e evidence suggests that there is an association between Down's syndrome and anatomical abnormalities in the duodenum [4,6]. Most of the reported cases on paediatric gastric emphysema with duodenal obstruction have described the condition in children with Down's syndrome [1,2,10,13].…”

Section: Discussionmentioning

confidence: 99%

“…Congenital duodenal web is a known cause of neonatal duodenal obstruction, and depending on the type of the web, the clinical presentation and the age of the presentation may vary [5]. Only a limited number of case reports have been published on congenital duodenal web leading to duodenal obstruction and presenting with gastroduodenal emphysema in infancy [1,2,6]. Windsock deformity is another uncommon association with duodenal web reported in the literature [5,7].…”

Section: Introductionmentioning

confidence: 99%

Gastroduodenal Emphysema with Portal Venous Air due to Congenital Duodenal Web in a Child: A Case Report and Review of Literature

Wettasinghe¹,

Rosairo

Kiriwattuduwa³

et al. 2020

Case Reports in Pediatrics

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Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent  peristalsis against the duodenal membrane, there is progressive stretching of the duodenal web leading to windsock deformity. We describe a rare case of a child with gastroduodenal emphysema and portal venous air due to duodenal obstruction secondary to a duodenal web. An eighteen-month-old male child, who was under investigation for failure to thrive, presented with a history of persistent projectile vomiting and progressive abdominal distension for two days. The abdominal ultrasound scan revealed air within the portal vein and in the wall of the stomach. Plain X-ray abdomen confirmed the presence of gas in the gastric wall and in the proximal duodenal wall. Upper gastrointestinal contrast study revealed complete obstruction at the second part of the duodenum. The child underwent emergency laparotomy, which revealed a duodenal web as the cause of the duodenal obstruction. During the surgery, windsock deformity was noted. This case illustrates that although rare, proximal duodenal obstruction due to duodenal web may present in early childhood and that alarming imaging features such as gastric emphysema and portal venous air could be associated with benign conditions.

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Gastric emphysema in a child with congenital duodenal diaphragm

Cited by 9 publications

References 6 publications

Gastric Pneumatosis in a Premature Neonate

Gastric Pneumatosis in a Premature Neonate

Gastric Pneumatosis in a Preterm Infant: a Case Report and Review of Literature

Gastroduodenal Emphysema with Portal Venous Air due to Congenital Duodenal Web in a Child: A Case Report and Review of Literature

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