Articles, Issue 3/2024

Case Report of a Child with a Congenital Antral Web and Clinical Symptoms of Gastroesophageal Reflux Disease

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D. Kofinova, E. Lazarova, N. Tolekova, P. Mutafchieva, Ya. Pakhnev, E. Rangelov, Ts. Georgiev


Abstract

Gastric antral web is a thin mucous membrane localized approximately 2 cm proximally to the
prepyloric region which causes gastric outlet obstruction. Clinical manifestations include recurrent
vomiting of nonbilious material, feeding difficulties, nausea, early satiety and epigastric pain. The
symptoms are non-specific and often those patients are misdiagnosed with gastroesophageal reflux
disease, food allergies and other diseases. We present a clinical case of a thirteen-month-old girl with
gastric antral web, who has been treated six months for а gastroesophageal reflux disease. After initiation
of complementary feeding vomiting exacerbated, hematemesis with melena and failure to thrive occurred.
The patient has been successfully surgically treated without any complications.
Key words: antral web, child, GERD, vomitin g

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Bibliography

  1. Lone YA, Hushain D, Chana RS, Khan RA, Sachdeva S, Mushtaq E. Primary acquired gastric outlet obstruction in children: A retrospective single center study. J Pediatr Surg. 2019 Nov;54(11):2285-2290. 
  2. Sharma KK, Ranka P, Goyal P, et al. Gastric outlet obstruction in children: an overview with report of “Jodhpur disease” and Sharma’s classification. J Pediatr Surg 2008;43(10):1891–7.
  3. Ferguson C, Morabito A, Bianchi A (2004) Duodenal atresia and gastric antral web. A significant lesson to learn. Eur J Pediatr Surg 14:120–122
  4. Nam S, Koo SH, Chung ML, Jung YJ, Lim YJ. Congenital antral web in premature baby. Pediatr Gastroenterol Hepatol Nutr 2013;16:49-52.
  5. Lui KW, Wong HF, Wan YL, Hung CF, Ng KK, Tseng JH. Antral web: a rare cause of vomiting in children. Pediatric Surg Int 2000;16:424-5.
  6. Bell MJ, Ternberg JL, McAlister W, Keating JP, Tedesco FJ. Antral diaphragm–a cause of gastric outlet obstruction in infants and children. J Pediatr 1977; 90: 196-202
  7. Bjorgvinsson E, Rudzki C, Lewicki AM. Antral web. Am J Gastroenterol 1984; 79: 663-665
  8. Van Winckel MA, Afschrift MB, Vande Walle JG. Ultrasound diagnosis of a prepyloric diaphragm. J Clin Ultrasound 1994; 22: 141- 143
  9. Mandell GA. Association of antral diaphragms and hypertrophic pyloric stenosis. AJR Am J Roentgenol 1978; 131: 203-206
  10. Berr F, Rienmueller R, Sauerbruch T. Successful endoscopic transection of a partially obstructing antral diaphragm. Gastroenterology 1985;89:1147-51.
  11. Nam SH, Koo SH, Chung ML, Jung YJ, Lim YJ. Congenital antral web in premature baby. Pediatr Gastroenterol Hepatol Nutr. 2013 Mar;16(1):49-52.
  12. Amin R, Martinez AM, Arca MJ. Diagnosis and treatment of gastric antral webs in pediatric patients. Surg Endosc. 2019 Mar;33(3):745-749.
  13. Srivastava P, Gangopadhyay A, Upadhyaya V, Sharma S, Jaiman R, Kumar V. Unusual acquired gastric outlet obstruction during infancy: a case report. Cases J. 2008 Oct 15;1(1):237.
  14.  Jung SE, Yu CS, Lee SC, Park KW, Kim WK. The surgical treatment for congenital gastric outlet obstruction. J Korean Surg Soc 1993;44:382-5.
  15.  Jung J, Moon KR. A case of an antral web with a gastric ulcer due to ibuprofen. Korean J Pediatr Gastroenterol Nutr 2010;13:66-9.
  16. Chew AL, Friedwald JP, Donovan C. Diagnosis of congenital antral web by ultrasound. Pediatr Radiol 1992; 22: 342-343
  17. Lu JP, Huang Y, Wu J, Chen SY. Uncommon congenital antral web misdiagnosed twice as a pyloric ulcer: successful treatment with endoscopic balloon dilatation. Turk J Pediatr 2014; 56: 100-102
  18. Peck J, Khalaf R, Marth R, Phen C, Sosa R, Cordero FB, Wilsey M. Endoscopic Balloon Dilation for Treatment of Congenital Antral Web. Pediatr Gastroenterol Hepatol Nutr. 2018 Oct;21(4):351-354.
  19. Morales SJ, Nigam N, Chalhoub WM, Abdelaziz DI, Lewis JH, Benjamin SB (2017) Gastric antral webs in adults: a case series characterizing their clinical presentation and management in the modern endoscopic era. World J Gastrointest Endosc 16:19–25

Address for correspondence::

Consultant in pediatric gastroenterology, hepatology and nutrition
UMHATEM “N. I. Pirogov”
Department of pediatric abdominal surgery
21, “Gen. E. I. Totleben”, Blvd.
1606, Sofia, Bulgaria
e-mail: kofinova@abv.bg