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Multiple associated anomalies in a single patient of duodenal atresia: a case report

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Abstract

Background

Duodenal atresia is a common cause of intestinal obstruction in neonates. It is associated with other congenital anomalies like Down's syndrome, annular pancreas etc.

Case presentation

We present a case of a two days old male baby presented to us with bilious vomiting since birth. It was associated with Down's syndrome, Annular pancreas and Malrotation.

Conclusion

Duodenal atresia is associated with other congenital anomalies but more than one congenital anomalies in a single patient is very rare.

Background

The duodenum is the most common site of intestinal obstruction accounting for nearly half of all cases [1]. The incidence of duodenal atresia is estimated as 1 in 6000–10000 births [2]. Embryological basis for etiology of duodenal atresia are thought to be due to errors of recanalization [3]. Approximately half of all infants with duodenal atresia or stenosis will also have a congenital anomaly of another organ system [4].

Duodenal atresia is associated with Down's syndrome (30%), annular pancreas (23%), congenital heart disease (22%), malrotation (20%), oesophageal atresia (8%), others (20%) [5].

The mainstay of treatment is surgical intervention. Duodenoduodenostomy is most frequently performed operation.

We report a case of duodenal atresia associated with more than one congenital anomalies.

Case presentation

A male baby 2 days old presented to us for bilious vomiting since birth. On examination patient has features of Down's syndrome and no other obvious anomaly. A nasogastric tube is passed and 40–50 ml bilious fluid aspirated. Xrays abdomen erect film showed a double bubble sign. Provisional diagnosis of duodenal atresia made and patient was optimized for surgery 1, 2.

Figure 1
figure1

X-rays radiograph abdomen (erect posture) showing a double bubble sign indicative of duodenal obstruction.

Figure 2
figure2

Picture of the patient with down syndrome manifestations.

At operation we found duodenal atresia, annular pancreas and malrotaion of gut.

Duodenoduodenostomy was peformed. Recovery of patient was uneventful.

Conclusion

Duodenal atresia is frequently associated with other congenital anomalies but combination of anomalies in a single patient is very rare. This report illustrates a rare setting in which three associated congenital anomalies were present in a single patient of duodenal atresia.

Consent

Written informed consent was obtained from the parents for publication of this case report.

References

  1. 1.

    Dalla Vecchia LK, Grosfeld JL, West KW, et al: Intestinal atresia and stenosis: A 25 year experience with 227 cases. Arch Surg. 1998, 133: 490-10.1001/archsurg.133.5.490.

  2. 2.

    Fonkalsrud EW, DeLorimier AA, Hays DM: Congenital atresia and stenosis of the duodenum: A review compiled from the members of the surgical section of the American Academy of Pediatrics. Pediatrics. 1969, 43: 79.

  3. 3.

    Lambercht W, Kluth D: Heriditary multiple atresias of gastrointestinal tract: Report of a case and review of literature. J Pediatr Surg. 1998, 33: 794-10.1016/S0022-3468(98)90225-1.

  4. 4.

    Bailey PV, Tracy TFJ, Connors RH, et al: Congenital duodenal obstruction: A 32 year review. J Pediatr Surg. 1993, 28: 92-10.1016/S0022-3468(05)80364-1.

  5. 5.

    Sweed Y: Duodenal obstruction. Newborn surgery. Edited by: Puri P. 2003, London, Arnold, 423-2

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Acknowledgements

We are grateful to Prof. Dr.M Afzal Sheikh, Dr.M.Sharif, Dr.Afzal Sipra, Dr. Shahid Iqbal, Dr.Nasir Mahmood, Dr.Arsalan Qureshi and other colleagues for giving suggestions and comments.

Author information

Correspondence to Bilal Mirza.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

BM presented the case history, researched the topic and helped draft the manuscript. LI reviewed the literature and drafted the manuscript. MS was the supervising consultant paediatric surgeon who supervised the surgery. AS is head of department helped and guided for preparation of case report. All authors read and approved the final manuscript.

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Authors’ original file for figure 1

Authors’ original file for figure 2

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mirza, B., Ijaz, L., Saleem, M. et al. Multiple associated anomalies in a single patient of duodenal atresia: a case report. Cases Journal 1, 215 (2008) doi:10.1186/1757-1626-1-215

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Keywords

  • Congenital Anomaly
  • Congenital Heart Disease
  • Intestinal Obstruction
  • Single Patient
  • Provisional Diagnosis