A 28-week-gestation black male infant with a birth weight of 1270 g was delivered by cesarean section. After feedings were initiated, the baby developed intermittent feeding intolerance with nonbilious emesis and large gastric aspirates. Plain roentgenograms of the abdomen were normal (Fig 1). The patient was placed on continuous oral gastric feeding and improved slowly. Because of recurring feeding intolerance and bradycardia, a barium esophagogram was obtained. This study documented an episode of gastroesophageal reflux. The feeding intolerance continued despite treatment of gastroesophageal reflux with bethanechol and aluminum hydroxide (Maalox).
An upper gastrointestinal series was repeated and a view of the stomach and duodenum is shown (Fig 2).
Denouement and Discussion
Obstructing Annular Pancreas
Annular pancreas, an uncommon anomaly, is a ring of pancreatic tissue surrounding the second part