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Clinical Pediatrics
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Food Refusal as an Unusual Presentation in a Toddler With Duodenal Web

Wikrom Karnsakul, MD

Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, wkarnsakul{at}hsc.wvu.edu

Stacey Gillespie, RN

Department of Pediatrics

Mary L. Cannon, MD

Department of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia

Tarun Kumar, MD

Department of Surgery Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia

Duodenal web most commonly presents with a history of vomiting and failure to thrive in the early infancy period. This study reports on a child who had an initial presentation of feeding intolerance and rare nonbilious emesis. The unusual presentation of food refusal directed the investigation to an upper endoscopy to look for evidence of gastrointestinal mucosal disease such as gastroesophageal reflux disease, peptic ulcer disease, Helicobacter pylori infection, and food allergy including celiac disease. The finding of duodenal web with a central aperture was unexpected but explains the mild degree of her gastrointestinal symptoms.

Key Words: food refusal • duodenal web • late presentation

This version was published on January 1, 2009

Clinical Pediatrics, Vol. 48, No. 1, 81-83 (2009)
DOI: 10.1177/0009922808320796
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