Case report-A 20 month old girl was admitted for intractable vomiting over
several days, with no other symptoms. Family and personal history were not
contributive. Clinical and neurological examination, and routine blood test
s and investigations (plain abdominal jc ray, upper gastrointestinal tract
contrast study, abdominal ultrasonography) were normal. The upper gastroint
estinal endoscopy showed a mild antral gastritis and the second portion of
duodenum was occupied by a tough, fibrous mass partially embedded into the
papilla of Vater. The foreign body was removed and proved to be vegetable f
ibre (pineapple). Symptoms subsided immediately and the child was discharge
d with gastroprotective therapy. After two months, on endoscopic examinatio
n, the signs of gastropathy had cleared; the papilla of Vater was undamaged
, but unchomped food debris was again found in the duodenum.
Discussion-There are sporadic reports of foreign bodies retained into the p
apilla of Vater, all of them in adults. This child, though her papilla was
tiny, had no jaundice or pancreatitis, unlike most of the reported cases. T
his is the first report of this finding in a child. The cause of the vomiti
ng was not shown on abdominal ultrasonography or contrast study. It should
be added to the list of unusual causes of vomiting. and ray, though her pap
illa was jaundice or pancreatitis.