Case Report of Gastric Outlet Obstruc-tion from Gastrogastric Intussusception

with External Web of Stomach in Neonate

Chang HK, Hong YJ, Oh J-T, Choi SH, Han SJ

Department of Pediatric Surgery, Severance Childrens’ Hospital, Yonsei University College of Medicine

Case Presentation10 days / male

Chief Complanit : abdominal distension for 5days

NSVD at 35+2 wks with birth weight of 2.24 kg d/t PROMAPGAR 1’-7, 5’-8

ASD 2’ 3.5-4mm (improved 2wks later)

Abdominal sono at 2 days after birth : WNL

Abdominal distension at 6 days after birth

Enema resulting small amount of hard stool passing without im-provement of abdominal distension

NPO, IV hydration & decompression via gavage tube

Simple Abdominal X-ray at birthday

Simple Abdominal X-ray at 6 days after birth

Marked distention of stomachLarge air fluid level at stomach

without evidence of free air

UGI at 8 days after birth

Complete outlet obstruction of stomach

r/o impaction of lactobezoarr/o other cause of outlet obstruction such as spasm or volvulus – less likely

Abdominal Ultrasonography & CTat 10 days after birth

Gastric outlet obstructionr/o gastroduodenal or gastrogastric intussuscep-

tion

Abdominal Ultrasonography at 10 days after birth

Operative Findings

Broviac catheter insertion

Gastric outlet obtruction from gastrogastric retrograde intus-supection triggered from thin triangular-shaped membranous structure attached on anterior wall of antrum across the lesser curvature and greater curvature of stomach : manual reduction & excision

Adhesion between stomach and peritoneumVery thin whole gastric wall from the uncorrected distension

Linear longitudinal perforation of gastric wall along the greater curvature about 3cm in length : primary repair

Irrigation and drainage

Operative Findings

Abdominal X-ray at POD#1

Postoperative Progress

UGI at POD#8

UGI at POD#15

Postoperative Progress

3 hrs after 2nd UGI

3 days after 2nd UGI 4 days after 2nd UGI 2 months after oper-ation

Postoperative Progress

Conclusions

Gastric outlet obstruction with gastrogastric intussusception was occurred from thin triangular-shaped membranous structure at-tached on anterior wall of antrum across the lesser curvature and greater curvature of stomach. Although gastric outlet ob-struction is not common in neonate, this anomaly of stomach should be considered as one of the cause of gastric outlet ob-struction in neonate.

Perforation of gastric wall occurred from distended stomach with gastric outlet obstruction because the distended stomach was not successfully decompressed preoperatively.

Gastrogastric intussusception was reduced and not recurred by excision of external web of stomach which was considered as a lead point of intussusception.