Background: Down syndrome (DS) is commonly associated with gastrointestinal (GI) anomalies—esophageal abnormalities, though rare, present significant concerns, especially in children with DS. Case Presentation: A 3-year-old male with DS presented with persistent vomiting. Diagnostic investigations revealed a foreign body lodged above a lower esophageal stricture, likely an esophageal ring, as seen in barium studies. Subsequent upper endoscopy confirmed these findings and incidentally identified a peri-pyloric pancreatic rest. The child underwent successful endoscopic intervention, leading to symptom resolution and clinical improvement. Conclusion: This case highlights the rare co-occurrence of an esophageal ring and peri-pyloric pancreatic rest in a child with DS. Early diagnosis and tailored management are crucial for alleviating symptoms and enhancing the quality of life in DS patients with gastrointestinal anomalies.
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