Abstract
Down syndrome (DS) is frequently associated with gastrointestinal (GI) anomalies, with duodenal atresia or stenosis being among the most common. We report a five-year-old boy with DS and hypothyroidism who presented with an acute abdomen and was found to have duodenal stenosis complicated by foreign body ingestion. Surgical intervention revealed significant duodenal narrowing with the impaction of 239 date seeds. This case highlights the importance of early screening for GI anomalies in DS patients, especially when symptoms are atypical or prolonged.