Case Report of Gastric Outlet Obstruction from Gastrogastric Intussusception with External Web of Stomach in Neonate Chang HK, Hong YJ, Oh J-T, Choi SH, Han SJ Department of Pediatric Surgery, Severance Childrens’ Hospital, Yonsei University College of Medicine

Case Presentation 10 days / male Chief Complanit : abdominal distension for 5days NSVD at 35+2 wks with birth weight of 2.24 kg d/t PROM APGAR 1’-7, 5’-8 ASD 2’ 3.5-4mm (improved 2wks later) Abdominal sono at 2 days after birth : WNL Abdominal distension at 6 days after birth Enema resulting small amount of hard stool passing without improvement of abdominal distension NPO, IV hydration & decompression via gavage tube

Simple Abdominal X-ray at birthday

Simple Abdominal X-ray at 6 days after birth Marked distention of stomach Large air fluid level at stomach without evidence of free air

UGI at 8 days after birth Complete outlet obstruction of stomach r/o impaction of lactobezoar r/o other cause of outlet obstruction such as spasm or volvulus – less likely

Abdominal Ultrasonography & CT at 10 days after birth Gastric outlet obstruction r/o gastroduodenal or gastrogastric intussusception

Abdominal Ultrasonography at 10 days after birth

Operative Findings Broviac catheter insertion Gastric outlet obtruction from gastrogastric retrograde intussupection triggered from thin triangular-shaped membranous structure attached on anterior wall of antrum across the lesser curvature and greater curvature of stomach : manual reduction & excision Adhesion between stomach and peritoneum Very thin whole gastric wall from the uncorrected distension Linear longitudinal perforation of gastric wall along the greater curvature about 3cm in length : primary repair Irrigation and drainage

Operative Findings

Abdominal X-ray at POD#1 Postoperative Progress UGI at POD#8

UGI at POD#15 Postoperative Progress 3 hrs after 2 nd UGI

3 days after 2 nd UGI4 days after 2 nd UGI2 months after operation Postoperative Progress

Conclusions Gastric outlet obstruction with gastrogastric intussusception was occurred from thin triangular-shaped membranous structure attached on anterior wall of antrum across the lesser curvature and greater curvature of stomach. Although gastric outlet obstruction is not common in neonate, this anomaly of stomach should be considered as one of the cause of gastric outlet obstruction in neonate. Perforation of gastric wall occurred from distended stomach with gastric outlet obstruction because the distended stomach was not successfully decompressed preoperatively. Gastrogastric intussusception was reduced and not recurred by excision of external web of stomach which was considered as a lead point of intussusception.