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Mini Review Volume 5 Issue 5
An infant illustrating single bubble on his CXR
Seyyed-Mohsen Hosseininejad,2,3
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Fateme-Sadat Hosseininejad,1 Fateme-Sadat Tabatabaei2
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1Student Research Committee, School of Public Health, Shahroud University of Medical Sciences, Iran
2Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Iran
3Department of Orthopedics, School of Medicine, Shahid Beheshti University of Medical Sciences, Iran
Correspondence: Seyyed-Mohsen Hosseininejad, Elahiyeh, Bone, Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran,
Received: July 25, 2018 | Published: September 12, 2018
Citation: Hosseininejad FS, Hosseininejad SM. An infant illustrating single bubble on his CXR. J Lung Pulm Respir Res. 2018;5(5):143. DOI: 10.15406/jlprr.2018.05.00180
Abstract
A male infant presented with choking, post feeding non-bilious vomiting and abdominal distention without meconial defecation. His CXR showed single “bubble,” suggestive for pyloric atresia.After the standard stabilizing measures conducted, the operation room was arranged and he was underwent the corrective surgery via laparotomy. His postoperative period was unremarkable, with a decent outcome during3 years of follow-up visits.
Keywords:pyloric atresia, infant, non-bilious vomiting
Scenario and discussion
A male infant, on the second day of his life, was perceived to have choking, post feeding non-bilious vomiting and abdominal distention without meconial defecation. The infant had been born from a consanguineous marriage via natural delivery after the unprompted premature rupture of membranes while the gestational age of 36 weeks with a birth-weight of 2870 gr. first Physical examination after birth was unremarkable, and his breastfeeding had begun 8 hours after birth time, gradually. His Radiograph of the abdomen in the upright position showed a single “bubble,” (Figure1) signifying a dilated stomach with an air-fluid level, suggestive for congenital pyloric atresia, as well as presence of air distal to his stomach. Usually a single bubble designates congenital pyloric atresia.
Figure 1 The CXR showing "Single Bubble" in a 2-day-old neonate.
Pyloric Artesia is a closed condition of the external os of the stomach (the pylorus). Symptoms comprise non-bilious projectile vomiting. This most often happens when the neonate is starting feeding. The classic age for presenting the symptoms is 2 to 12 weeks of age.1 About 1 to 2 per 1000 neonates are affected. Male babies are influenced about 4 times more often than female ones. The first report on pyloric atresia was in 1888 with surgery management first done in 1912 by C Ramstedt.1−3 Congenital pyloric atresia is relatively an infrequent anomaly which could be accompanied with other abnormalities, such as epidermolysis bullosa, Down’s syndrome, intestinal atresia , esophageal atresia and congenital heartdisease.3 The exact etiology of pyloric atresia is still not clear.2 Risk factors include cesarean section, preterm labor birth, being first born and feeding with bottle.3 The diagnosis might be made by sensation of an olive-shaped mass in abdomen.1
Treatment begins by stabilizing measures including adjusting electrolytes and dehydration; then surgery.1,3
After the standard stabilizing measures conducted, the operation room was arranged and he was underwent the corrective surgery via laparotomy. The gastrotomy was carried out via laparotomy which disclosed a prepyloric membrane (type 1 congenital Pyloric Artesia), which was removed during a standard surgery, and parenteral nutrition was continued for 6 days. His postoperative period was unremarkable, with a decent outcome during 3 years of follow-up visits.
Conclusion
In all neonatal birth that evidence of abdominal distention and lack of defecation besides inability to intake feeding investigation for gastrointestinal anomalies must be considered.
Acknowledgements
None.
Conflicts of interest
Author declares that there is no conflict of interest.
References
- Ranells JD, Carver JD, Kirby RS, et al. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update. Adv Pediatr. 2011;58(1):195−206.
- Georgoula C, Gardiner M. Pyloric stenosis a 100 years after Ramstedt. Arch Dis Child. 2012;97(8):741–745.
- Parshotam G, Ahmed S, Gollow I. Single or double bubble: sign of trouble! Congenital pyloric atresia: report of two cases and review of literature. J Paediatr Child Health. 2007;43(6):502−503 .
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