Congenital Duodenal Stenosis Presenting with Bowel Obstruction Caused by Food Impaction in a Three-Year-Old Boy: A Case Report.

introductionCongenital duodenal stenosis (CDS) is often associated with trisomy 21 and is typically diagnosed in the neonatal period. However, some cases may present beyond infancy with episodes of acute gastroenteritis or foreign body impaction, which makes diagnosis challenging. This report describes a case in which a young child with trisomy 21 was diagnosed with CDS following an episode of acute bowel obstruction caused by an impacted mushroom. CASE PRESENTATION: A male infant was born at term without abnormal prenatal findings, including polyhydramnios. Although he was diagnosed with trisomy 21 after birth, no obvious congenital anomalies were identified. He began complementary feeding at 6 months of age and transitioned to a regular toddler diet at 2 years of age. At 3 years of age, he presented with recurrent vomiting at a local hospital and was initially treated for acute gastroenteritis. An upper gastrointestinal contrast study and contrast-enhanced CT raised suspicion for impaired passage at the duodenum. Consequently, the patient was referred to our department for further evaluation and management. Careful review of the CT images obtained at the referring hospital revealed a mushroom-shaped foreign body in the descending portion of the duodenum. A repeat contrast study demonstrated not only the foreign body but also indicated an underlying duodenal stenosis at the same site. Upper gastrointestinal endoscopy confirmed the duodenal stenosis and revealed an impacted mushroom blocking the opening, which was successfully removed endoscopically. Laparotomy was performed via an inverted Y-shaped umbilical incision, and a membranous stenosis in the descending portion of the duodenum was identified. Membrane resection and duodenoplasty were performed. The patient's postoperative course was favorable, and no recurrence has been observed during follow-up.

conclusionsLate-onset CDS can be detected following food impaction. This case highlights the importance of comprehensive imaging in such cases, including a contrast study and CT, which facilitates both endoscopic removal of the impacted food and definitive surgical management of the duodenal stenosis. Clinicians should maintain a high index of suspicion for CDS in children presenting with sudden or recurrent vomiting at any age, particularly in those with trisomy 21.