Bilious aspirates with metabolic acidosis in a premature infant ? congenital antral web: a case report

Abstract

Congenital antral web is a rare cause of obstruction in neonates. It is a thin mucosal diaphragm at 1-3 cm from the pyloroduodenal junction with a 1-2mm orifice. The baby was born to a non diabetic primigravida at 35 weeks of gestation with a birth weight of 2.12kg. Baby presented after 12 hours of birth with yellowish mucoid aspirates of 35ml without abdominal distension. Investigations revealed child to be having hypocalcemia and metabolic acidosis. X ray showed a dilated stomach without distal small bowel gas. Barium swallow was done which showed a dilated stomach with no passage of barium beyond the stomach. Baby underwent a emergency laparotomy on the second day of life with a incision of the web, pyloroplasty and a transanastomotic feeding tube insertion. Antral web should be considered in a case of premature neonate with a dilated stomach and bilious aspirates.