Gastromegaly from arterio-mesenteric compression of the duodenum in the new-born.

In this paper it is proposed to produce evidence that certain cases of obstructive vomiting in the newborn , simulating examples of intrinsic duodenal stenosis or atresia, are instances of duodenal ileus from arterio-mesenteric compression and are amenable to medical treatment; and to urge that where, in this type of case, radiological or other examination shows that the duodenal obstruction is not complete, duodenal ileus should be suspected and brief trial made of the effect of gastric lavage, in the hope of obviating the extreme risk of an abdominal operation. In support of these contentions three cases are reported; and it should be noted that, unlike the rare cases of duodenal ileus hitherto recorded in the very young, the obstruction is not associated with a gross megaduodenum although the duodenum is definitely larger than normal. Chronic duodenal ileus (arterio-mesenteric compression), now established as a comparatively rare condition in adults, is regarded as possessing two causative factors: first, the congenital anatomical factor, the compression of the duodenum by the root of the mesentery and the superior mesenteric artery, and secondly, the accessory factor of visceral distension or ptosis whereby the compression of the duodenum is increased. The congenital anatomical factor has had to be assumed, otherwise it would be difficult to see why all cases of visceral distension or ptosis should not show signs of duodenal obstruction. The importance of the congenital factor has been emphasised in the studies of chronic duodenal ileus in young children by the present writers" 2; and it is still more evident in examples of the same condition in the newborn such as are described in the present communication. In all cases in the newborn , and in most of those seen in early childhood, the presence of an obstructive factor dating from birth can be clearly traced. Nevertheless, even in early life, the importance of the accessory factor must not be underestimated. In babies this takes the form of a ' paralytic ' distension of the stomach, and this is responsible for the occurrence of the urgent vomiting of the