Trilogy of foregut, midgut and hindgut atresias presenting in reverse order.
We present a case of triple gut atresias (foregut, midgut and hindgut) with multiple congenital anomalies presenting as imperforate anus. Abdominal radiography showed the double bubble sign. Upper gastrointestinal study through a nasogastric tube confirmed duodenal obstruction. Exploratory laparotomy, duodeno-duodenostomy for duodenal atresia and a left descending colostomy for anorectal malformation were performed. During extubation, the nasogastric tube came out and could not be reinserted by the anaesthetic team under laryngoscopic guidance. A chest radiograph showed the tube curled in the upper pouch. Bronchoscopy and oesophagoscopy confirmed oesophageal atresia (OA) with a distal tracheoesophageal fistula (TOF). The patient underwent right-sided extrapleural thoracotomy and division of the fistula with primary repair of OA uneventfully. Triple gut atresias presenting in reverse order with multiple anomalies is rare and passage of a nasogastric tube into the stomach in the presence of OA+TOF is exceptional. Alimentary tract obstruction should be corrected in proximal to distal direction.
Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Ramnik V
RV
Patel
Neonatal and Paediatric Surgery, GOSH and ICH, London, UK.
Paul
P
Jackson
Neonatal and Paediatric Surgery, GOSH and ICH, London, UK.
Paolo
P
De Coppi
Neonatal and Paediatric Surgery, GOSH and ICH, London, UK.
Agostino
A
Pierro
D000005:Abdomen; D000015:Abnormalities, Multiple / Q000473:pathology* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000473:pathology* / Q000601:surgery; D003125:Colostomy; D004380:Duodenal Obstruction / Q000473:pathology* / Q000601:surgery; D004386:Duodenum / Q000473:pathology; D004933:Esophageal Atresia / Q000473:pathology* / Q000601:surgery; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000473:pathology* / Q000601:surgery; D007420:Intestine, Large / Q000473:pathology / Q000601:surgery; D007441:Intubation, Gastrointestinal; D013270:Stomach; D013909:Thorax; D014138:Tracheoesophageal Fistula / Q000473:pathology* / Q000601:surgery