Extremely Rare Neonatal Case With Pyloric Atresia, Heart Defects, Hypotonia, Jaundice, and Acidosis.

Pyloric atresia (PA) is an exceptionally rare congenital cause of gastric outlet obstruction, often associated with syndromic conditions such as epidermolysis bullosa (EB). This case highlights a diagnostically challenging presentation of non-syndromic pyloric atresia in a neonate, complicated by a moderate mid-muscular ventricular septal defect (VSD), metabolic acidosis, and physiologic hydronephrosis, without any cutaneous manifestations. Initial hypotonia and respiratory irregularities diverted suspicion toward neurological or septic etiologies, delaying definitive diagnosis. Imaging, including upper gastrointestinal contrast study and echocardiography, confirmed the diagnosis of complete gastric outlet obstruction due to PA and coexisting VSD. The patient underwent successful gastro-duodenostomy with resolution of symptoms and stable postoperative recovery. This case underscores the importance of maintaining a high index of suspicion for gastrointestinal obstruction in neonates with polyhydramnios and early feeding intolerance, even in the absence of classic syndromic features. Comprehensive, multidisciplinary evaluation-incorporating pediatric surgery, neonatology, and cardiology-is essential to address overlapping congenital anomalies and optimize outcomes. This report contributes to the limited literature on non-syndromic PA with multisystem involvement.