Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web—A 20-Year Experience of a Referral Center

Background: Antral web is a rare cause of gastric outlet obstruction in children. The presentation is diverse, depending on the degree of obstruction. Unfortunately, the guidance of management is still lacking.Methods: This study retrospectively evaluated the presentations, management, and outcomes of the pediatric antral web based on a 20-year experience in a referral center.Results: A total of 23 cases were included. The median age of diagnosis was 10 months (interquartile range, IQR, 0.8–23 months). Main presentations comprised vomiting (83%) and upper gastrointestinal (UGI) bleeding (48%). Concurrent gastric ulcers were common (68%). A total of 13 cases (57%) underwent interventional treatment. The median duration from diagnosis to intervention (DtI) was 10 days, but five with longer DtI, ranged from 30 to 755 days. Among the 15 cases with concurrent gastric ulcers, 10 patients received intervention, immediately in six but delayed in four. Surgical treatments (N = 12) achieved a cure in 11, with one rescued by endoscopic treatment.Conclusions: Children who suffer from early gastric ulcers with outlet obstruction shall raise the suspicion of the antral web. Complete obstruction madates early intervention. Around half of the cases with adequate feeding and growth need no intervention. Recurrent obstructive symptoms or adjacent ulcers justify a switch from observation to intervention to avoid complications or growth faltering.

Prenatal Diagnosis of Prepyloric Diaphragm: A Case Report

The prepyloric diaphragm (A type of pyloric atresia) is a rare type of congenital malformation of gastrointestinal tract of unknown etiology. A thin two layered mucus membrane of about 2 to 4 mm, proximal to pylorus causes the gastric outlet obstruction in neonate. We are reporting a case of prepyloric diaphragm which had been diagnosed at 37 weeks of gestation by Ultrasonography and diagnosis was confirmed after birth during surgery. Prenatal ultrasonography of a 37 weeks pregnant mother revealed polyhydramnios, persistently dilated, a fluid filled blind sac at epigastrium and right hypochondrium with peristaltic wave and to & fro movements of fluid contents. There was no double bubble sign. The baby boy was born by Caesarean Section. After breast feeding, baby had non-bilious vomiting with mild abdominal distension. Postnatal ultrasonography showed dilated fluid filled stomach. Exploratory laparotomy on 14thday of life revealed a prepyloric diaphragm with a central hole, 1 cm proximal to the pylorus. The 2 mm thick diaphragm was excised circumferentially. Postoperative period was uneventful. Milk feeding started at 6th post-operative day and discharged with advice at 7th post-operative day. Prepyloric diaphragm or antral web is to be considered as provisional diagnosis if there is prenatal suspicion of gastric outlet obstruction, polyhydramnios of mother and persistent non-bilious vomiting in neonate; as simple excision of the diaphragm is curative for this unusual abnormality if there is no other associated abnormality. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 67-69

Gastric Antral Webs: Anatomical Variants and Appropriate Endotherapy

We report the case of a 65-year-old patient with rheumatoid arthritis presenting with dyspeptic symptoms. Upper gastrointestinal (UGI) endoscopy revealed a gastric antral web, which was confirmed by UGI series. The presence of webs in the gastrointestinal tract, excluding the esophagus, is a rarity. Here, we highlight the anatomical variations in antral webs and endoscopic diagnosis, which ultimately influence the type of endotherapy.

Antral mucosal diaphragm as a misdiagnosed cause of gastric outlet obstruction: case report and review of the literature

The antral web is a thin septum with an aperture varying from 2 to 30 mm usually discovered in middle or late life because of associated gastric outlet obstruction or peptic ulcer. It is commonly mistaken for a pyloric obstruction. Since surgical excision of the antral diaphragm can cure patient’s symptoms, a correct diagnosis is important for not delaying treatment. However, the diagnosis is difficult even after adequate investigation with barium upper gastrointestinal x-ray series or endoscopy. Therefore, the present study seek to notify this pathology as a possible cause of gastric outlet obstruction providing an illustrative case report and review the pertinent literature. Case Report: A 56 years old man presented complaint of pyrosis, epigastric fullness after eating and loss of weight for over three years. His past clinical history revealed a perforated peptic ulcer surgery three years ago. Investigation was initially performed with barium upper gastrointestinal x-ray which suggested pyloric stenosis secondary to the previous surgery. Gastric endoscopy identified a mucous tunnel formation with a 10 mm diameter aperture in the pre-pyloric region. The patient was also submitted to a computerized tomography (CT) of the abdomen and pelvis for surgical planning for correction of pyloric stenosis and demonstrated an apparently thickening of the gastric wall and reduction of the diameter of the antropyloric region. The patient was then submitted to lapartomy with resection of the antral web. After 6 months, the patient is asymptomatic.