Abstract

Gastric pneumatosis is an uncommon radiologic finding in children and may suggest underlying gastrointestinal pathology. Herein, we reported a five-month-old male infant with Down syndrome who presented with a one-month history of recurrent nonbilious vomiting. Upright abdominal radiography showed a markedly dilated stomach and intramural gas along the gastric wall, raising suspicion for proximal intestinal obstruction. An upper gastrointestinal contrast study revealed a partial obstruction at the level of the duodenum. Surgical exploration identified an annular pancreas encircling the second portion of the duodenum. Due to the anatomical configuration, a duodenojejunostomy was performed. The patient tolerated postoperative enteral feeding and was discharged uneventfully. At the six-month follow-up, the patient remained asymptomatic with appropriate weight gain. This case demonstrates that gastric pneumatosis, although rare, may serve as an early indicator of upper gastrointestinal obstruction. Recognizing this finding on plain radiographs can expedite further diagnostic evaluation and enable timely surgical management. Clinicians should consider anatomical causes, including congenital duodenal anomalies, particularly in syndromic infants with persistent vomiting.

Citation: İnanç İ, Yıldız S, Keskin Çakıcı M, Başaran ÜN. Is gastric pneumatosis a clue to upper gastrointestinal obstruction?. Turkish J Ped Surg 2026;40(2):106-109. doi: 10.62114/JTAPS.2026.139.