title: Neonatal gastric outlet obstruction by isolated pyloric atresia, an often forgotten diagnosis.
abstract: BACKGROUND
  Pyloric atresia (PA) is a rare condition, and may be misdiagnosed and especially confused for duodenal atresia pre-operatively. We looked for clues to avoiding pre-operative misdiagnosis and hence allow the best neonatal medical and surgical management.
  
  
  METHODS
  A retrospective case-note review was carried out of the five patients managed in four centres with the diagnosis of isolated PA. We focused on antenatal ultrasound findings, postnatal clinical and radiological features, operative findings, surgical procedures and outcomes.
  
  
  RESULTS
  Four patients had polyhydramnios and one double bubble sign on antenatal ultrasound. After birth, non-bilious vomiting and upper abdominal distension were the main symptoms. Gastric decompression showed non-bilious gastric fluid. Radiological findings were a large gastric air bubble with no gas beyond in all cases. The diagnosis of duodenal atresia was postulated at first in all cases. The diagnosis of PA was established peroperatively. One patient referred late, died 13-day post-operatively of cardiopulmonary failure secondary to a severe pneumonia that may be related to aspiration syndrome. Outcomes were otherwise satisfactory.
  
  
  CONCLUSIONS
  Even though it is a rare diagnosis, PA has a specific clinical and radiological presentation underlined here that should be kept in mind when managing a neonate with a gastric outlet obstruction.
authors.affiliation: a Department of Pediatric Surgery , Le Mans Hospital 194 avenue Rubillard , 72037 Le Mans , France ;
authors.forename: Antoine
authors.initials: A
authors.lastname: Mboyo
authors.affiliation: a Department of Pediatric Surgery , Le Mans Hospital 194 avenue Rubillard , 72037 Le Mans , France ;
authors.forename: Pauline
authors.initials: P
authors.lastname: Clermidi
authors.affiliation: b Department of Pediatric Surgery , Angers University Hospital 4 rue Larrey , 49933 Angers Cedex 9 , France ;
authors.forename: Guillaume
authors.initials: G
authors.lastname: Podevin
authors.affiliation: c Department of Pediatric Surgery and Urology , Wroclaw Medical University M Curie-Sklodowskiej 52 street , 50-369 Wroclaw , Poland ;
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patkowski
authors.affiliation: c Department of Pediatric Surgery and Urology , Wroclaw Medical University M Curie-Sklodowskiej 52 street , 50-369 Wroclaw , Poland ;
authors.forename: Maciej
authors.initials: M
authors.lastname: Baglaj
authors.affiliation: c Department of Pediatric Surgery and Urology , Wroclaw Medical University M Curie-Sklodowskiej 52 street , 50-369 Wroclaw , Poland ;
authors.forename: Sylwester
authors.initials: S
authors.lastname: Gerus
authors.affiliation: a Department of Pediatric Surgery , Le Mans Hospital 194 avenue Rubillard , 72037 Le Mans , France ;
authors.forename: Abdelfetah
authors.initials: A
authors.lastname: Lalioui
authors.affiliation: d Department of Pediatric Surgery , Nantes University Hospital 38 boulevard Jean-Monnet , 44093 Nantes Cedex 1 , France ;
authors.forename: Stéphan de
authors.initials: Sd
authors.lastname: Napoli-Cocci
authors.affiliation: e Department of Pediatric Surgery , Tours University Hospital - Hopital Clocheville, 49 boulevard Béranger , 37044 Tours , France.
authors.forename: Michel
authors.initials: M
authors.lastname: Robert
mesh_terms: D000714:Anastomosis, Surgical; D003937:Diagnosis, Differential; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia; D007813:Laparotomy / Q000379:methods; D008297:Male; D011296:Prenatal Diagnosis; D011708:Pylorus / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: Diagnostic errors; duodenal obstruction; newborn; pyloric stenosis