2020 Volume 56 Issue 1 Pages 82-85
A 17-day-old boy admitted to our hospital with complaint of frequent nonbilious vomiting and weight loss, and diagnosed with hypertrophic pyloric stenosis (HPS). On the night of admission, the vomited matter had become bilious; however, an ultrasonography showed no findings that indicated intestinal malrotation. An atropine therapy stopped the bilious vomiting; however, the bilious vomiting reappeared a few weeks later. An upper gastrointestinal series showed a pyloric string sign and regurgitation of the contrast medium to the stomach. On the basis of these findings, he was diagnosed as having HPS complicated by postpapillary duodenal obstruction. Laparotomy showed an anomalous membranous ligament between the posterior side of the transverse colon and the retroperitoneum caudal to the gallbladder. After dividing the ligament induced extrinsic distal duodenal obstruction, Ramstedt’s procedure was performed. Intraoperative duodenography showed no obstruction. His postoperative clinical course was uneventful. The HPS in our case showed an atypical symptom, that is, bilious vomiting with extrinsic distal duodenal obstruction caused of an anomalous ligament.
