GASTRIC ANOMALIES

Congenital gastric outlet obstruction is extremely rare. It occurs either in the pyloric or antral region. Antral membranes (web or diaphragm) are thin, soft and pliable, composed of mucosa/submucosa, and located eccentric 1-3 cm proximal to pyloro-duodenal junction. They probably represent the developmental product of excess local endodermal proliferation and redundancy. The diagnosis should rely on history, contrast roentgenology studies and endoscopic findings. Symptoms are those of recurrent non-bilious vomiting and vary according to the diameter of aperture of the membrane. There is a slight male predominance with fair distribution between age groups in children. Associated conditions: pyloric stenosis, peptic ulcer and cardiac. History of polyhydramnios in the mother. Demonstration of a radiolucent line perpendicular to the long axis of the antrum is diagnostic of a web. Endoscopy corroborates the diagnosis. Management can be either surgical or non-surgical. Surgical Tx is successful in symptomatic pt. and consist of pyloroplasty with incision or excision of the membrane. Other alternative is endoscopic balloon dilatation or transection of the web. Non-obstructive webs found incidentally can be managed medically with small curd formula and antispasmodics. The presence of an abnormally dilated gastric bubble in prenatal sonography should alert the physician toward the diagnosis of congenital antro-pyloric obstruction.