Delayed gastric emptying in a neonate, associated with a partial defect in the gastric smooth muscle.

A girl born after 36 weeks' gestation had emesis 15 hours after birth. She required total parenteral nutrition (TPN) because of persistent gastric retention. When milk was given, the volume of gastric aspirate 3 hours after feeding often was greater than the volume given. Domperidon and erythromycin were ineffective. Upper gastrointestinal series showed slow gastric emptying but no abnormalities in the stomach. No stenosis or obstruction below pylorus was found. Endoscopy showed normal gastric mucosa. Manometry showed normal antroduodenal motility patterns. Transpyloric feeding, which started at age 73 days, was successful and enabled cessation of the TPN. Laparotomy at 119 days of age showed partial absence of the muscle and serosal layer in the anterior wall of the gastric body (1 x 4 cm). The mucosal layer was intact and partly adhered to the peritoneum and the left lobe of the liver. The defect was surgically corrected by plicating the place. The postoperative course was excellent, and oral feeding was fully established within 2 weeks. Although the cause of the partial muscle defect in the case is unclear, this case suggests that this rare condition can cause severe chronic gastric retention.