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October 1995

Radiological Case of the Month

Author Affiliations

From the Department of Pediatrics and Medicine, Wright State University School of Medicine (Dr Mezoff), and the Division of Pediatric Gastroenterology and Nutrition, Childrens Medical Center (Dr Mezoff), Dayton, Ohio; the Department of Pediatrics, University of Connecticut School of Medicine, Farmington (Dr Hyams); and the Division of Gastroenterology and Nutrition, Hartford (Conn) Hospital (Dr Hyams).

Arch Pediatr Adolesc Med. 1995;149(10):1169-1170. doi:10.1001/archpedi.1995.02170230123019

A WHITE MALE INFANT presented at 3½ months of age with vomiting and weight loss. His symptoms progressively worsened prior to referral at 5 months of age to a pediatric gastroenterologist. His symptoms included daily effortless regurgitation and intermittent projectile vomiting. Radiographic series of the upper gastrointestinal tract (Figure, left) demonstrated a narrowed and elongated pylorus with a multilobular filling defect in the duodenal bulb, associated with delayed gastric emptying. Endoscopic evaluation of the same area showed a markedly swollen and erythematous pylorus with a pinpoint opening. A small polypoid lesion emanating from the antropyloric folds was visualized passing back and forth through the pylorus to the duodenum.

A biopsy specimen of this region revealed eosinophilic infiltration and hyperplasia of the foveolar mucosa. The patient was given a protein hydrolysate formula, and within 2 weeks his vomiting had significantly improved. Repeated radiographic series of the upper gastrointestinal tract (Figure, right)