Congenital prepyloric web: A diagnostic and therapeutic challenge
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Updated: Nov 7, 2026

Laparoscopic Pyeloplasty via Transmesenteric Approach for Pediatric Ureteropelvic Junction Obstruction
Published on: July 7, 2026
J G Montaño Durón1, C Gutiérrez Ávalos1, I V Medina López2
1Pediatric Surgery Department. Hospital Infantil de México Federico Gómez. Ciudad de México, México.
Introduction:
Neonatal gastric outlet obstruction (NGOO) is a common pathology during the first month of life. Its main cause is hypertrophic pyloric stenosis; congenital prepyloric webs are exceptional, making timely diagnosis and treatment difficult.
Case Report:
Female neonate with prenatal gastromegaly and polyhydramnios, postprandial vomiting, and weight loss in the first 4 days. NGOO was diagnosed with ultrasound findings suggestive of pyloric hypertrophy. Given the clinical-radiological discordance, endoscopy and a gastrogram were performed, followed by surgical exploration and pyloromyotomy. Due to persistent obstruction, confirmed by intraoperative gastrogram and endoscopy, a Heineke-Mikulicz pyloroplasty was performed, identifying and resecting a prepyloric web. She had a favorable evolution, with no recurrence at five years.
Comments:
Clinical-radiological discordance should alert to rare causes of NGOO. Intraoperative multimodal evaluation allowed establishing the diagnosis, modifying the surgical strategy, and achieving definitive resolution in a single intervention, thus avoiding additional surgical procedures.
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