The infantвЂ™s vomiting was resolved, and she achieved appropriate weight gain in follow-up.Д¬ongenital intestinal obstructions can be classified as intrinsic (atresia, stenosis and web) or extrinsic (malrotation, LaddвЂ™s bands, annular pancreas, duplications and, rarely, a preduodenal portal vein). This was successfully repaired with a diamond-shaped duodenoduodenostomy, with uneventful postoperative recovery. Laparotomy on the third day of admission revealed duodenal stenosis in the second portion of the duodenum, proximal to the ampulla of Vater. Upper gastrointestinal contrast study showing dilated duodenum with tiny amount of contrast passing distallyДehydration and hypochloremic alkalosis were corrected over the following 72 h, and the stomach was decompressed with a nasogastric tube. The infantвЂ™s abdominal radiograph showed a small amount of gas in a single, mildly prominent structure in the mid-abdomen and a paucity of bowel gas in the remainder of the abdomen.ДЄn additional investigation revealed the diagnosis. Her abdominal ultrasound revealed stomach contents passing through a nonhypertrophied pylorus that was seen to open and close normally. Her urine pH was greater than 9.0 and specific gravity was 1.010 g/L she had normal microscopy, except for 2+ protein. The infantвЂ™s complete blood count was normal, apart from thrombocytosis (767Г—10 9/L). Both urea and creatinine concentrations were significantly elevated (blood urea nitrogen 22.7 mmol/L and creatinine 261 Ојmol/L). Electrolytes were abnormal with serum sodium 119 mmol/L, potassium 4.7 mmol/L, chloride lower than 50 mmol/L and glucose 10.9 mmol/L. Initial laboratory investigations revealed severe metabolic alkalosis with venous pH 7.64, PCO 2 50 mmHg, bicarbonate 54 mmol/L and base excess +26 mmol/L. The remainder of the examination was normal, apart from slight oral thrush.

There were no palpable masses, including no palpable вЂoliveвЂ™ when the baby was quiet. Her abdomen was soft, scaphoid and nontender, with no organomegaly. She was afebrile, with stable vital signs for her age, including a pulse rate of 120 beats/min after initial fluid resuscitation of 20 mL/kg of 0.9% saline followed by isotonic fluid at a maintenance rate. The infantвЂ™s admission weight was 2180 g (25% less than her birth weight), with the clinical appearance of significant dehydration and malnutrition (little subcutaneous fat and muscle wasting). The infant was otherwise healthy, with no fever, rash or systemic symptoms.Д«oth parents were healthy and of Italian descent. Her parents reported that there had been four to five wet diapers per day before admission. Her bowel movements were normal, apart from a few loose, nonbloody stools on the day of admission. She was offered approximately 60 mL of feed every 2 h to 3 h. The formula changes did not result in symptomatic improvement. The infant had been offered two different formulas (Enfamil and Goodstart ), and minimal expressed breastmilk by bottle since birth. She appeared hungry immediately after vomiting. By the time of admission, at three weeks of age, the infant had projectile nonbilious vomiting that occurred 1 h to 2 h after every attempted feeding. The vomiting progressively became more frequent and projectile in nature. Vomiting began at seven days of age, when nystatin was started for treatment of oral thrush. The infantвЂ™s birth weight was approximately 3 kg. The pregnancy was uncomplicated, apart from a positive screen for group B streptococcus, which was adequately treated during labour. The infant was born to a 31-year-old primiparous mother at 37 weeksвЂ™ gestation by spontaneous vaginal delivery. A 20-day-old female infant was transferred from a peripheral hospital with progressive vomiting and weight loss.

Projectile vomiting baby