Duodenal perforation associated with breath stacking and annular pancreas.

Gastrointestinal perforations have been reported occasionally in neonates. The authors describe a 9-month-old girl with mosaic trisomy 8 on home breath-stacking therapy who presented with an acute abdomen. A large perforation in the first portion of the duodenum was found as well as an incidental annular pancreas. Despite occupying approximately half of the circumference of the lumen, the perforation was able to be closed primarily without complications. Several etiologies have been suggested for intestinal perforations. This report hypothesizes the possible involvement of breath stacking in conjunction with partial obstruction by an annular pancreas.