A 4-Week-Old Boy Is Hospitalized with Persistent Vomiting, Fussiness, and Feeding

A 4-week-old boy is hospitalized with persistent vomiting, fussiness, and feeding intolerance.  The emesis was initially clear but became bilious in the last few hours.  The infant had been breastfeeding exclusively.  His temperature is 37.2 C (99.0 F) .  Blood pressure and pulse are normal.  Physical examination shows a normal abdomen with no rebound or guarding.  An upper gastrointestinal series is obtained urgently to evaluate for malrotation and volvulus and shows normal rotation but constriction of the duodenum.  An abdominal CT scan reveals pancreatic tissue encircling the duodenum.  Which of the following is the most likely cause of this patient's condition?

A) Aberrant differentiation of the midgut structures
B) Abnormal migration of the ventral pancreatic bud
C) Ectopic rests not connected to the pancreas
D) Failure of apoptosis in the dorsal pancreatic bud
E) Failure of the ventral and dorsal pancreatic bud to fuse

Correct Answer:

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