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Prepyloric gastric antral web: a puzzling epidemic
Insights
Antral webs, a rare cause of gastric outlet obstruction in children, present with vomiting. Radiography is key for diagnosis, with pyloroplasty often required for treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Antral webs and diaphragms are rare causes of gastric outlet obstruction in pediatric patients.
- Gastric outlet obstruction can significantly impact infant and child health.
Purpose of the Study:
- To describe the clinical presentation, radiographic findings, and management of antral webs in children.
- To highlight the diagnostic clues for antral webs on radiographic imaging.
Main Methods:
- Retrospective review of 28 pediatric cases diagnosed with antral webs over 26 months.
- Analysis of presenting symptoms, radiographic findings, and treatment outcomes.
Main Results:
- Nonbilious, projectile vomiting was the primary symptom in infants (<6 months).
- Older children presented with pain, vomiting, and postprandial fullness.
- Radiography revealed a characteristic wirelike transverse septum proximal to the pylorus, with poor antral filling as an early sign.
- Pyloroplasty was performed in 20 patients, often after failed medical management.
- Congenital abnormalities were noted in 28% of patients.
Conclusions:
- Antral webs are a treatable cause of gastric outlet obstruction in children.
- Radiographic findings, particularly poor antral filling and a transverse septum, are crucial for diagnosis.
- Surgical intervention (pyloroplasty) is frequently necessary for successful management.
Abstract:
Antral webs and diaphragms are considered a rare cause of gastric outlet obstruction in infants and children. A radiographic diagnosis of antral web was made in 28 children during a 26-mo period. Nonbilious, often projectile vomiting was the predominant presenting symptom in 24 infants who were less than 6 mo of age. The older children complained of pain, vomiting, fullness after eating, and eructation. The characteristic radiologic finging was a wirelike transverse septum 1--2 cm proximal to the pylorus. Poor antral filling was an important early clue in the radiographic search for the webs. Pyloroplasty was performed in 20 patients, frequently after failure of medical management of symptoms. Coexistent congenital abnormalities were present in 28% of patients. A search for environmental and familial factors has failed to elucidate any teratogenic influences in this population.