Abstract
Metabolic acidosis is often encountered in a sick neonate and intestinal duplication with heterotopic gastric mucosa is a well-established condition. We present a previously unreported relationship between neonatal metabolic acidosis, resulting from transperitoneal absorption of hydrochloric acid, and a ruptured non- communicating ileal duplication cyst with gastric mucosal heterotopia. The neonate recovered rapidly after resection of the ileal duplication. We present this case to highlight a rare but surgically correctable cause of neonatal metabolic acidosis.
Highlights
Causes of metabolic acidosis in the neonatal period include birth asphyxia, sepsis, cold stress, dehydration, congenital heart diseases, renal disorders and inborn errors of metabolism
A ruptured non-communicating, acid secreting ileal duplication cyst presenting with metabolic acidosis has not been reported, to the best of authors’ knowledge
Most small bowel duplications are noncommunicating and about 50% may contain ectopic gastric mucosa; around 10% can have more than one heterotopic mucosa
Summary
Causes of metabolic acidosis in the neonatal period include birth asphyxia, sepsis, cold stress, dehydration, congenital heart diseases (hypoplastic left heart syndrome, coarctation), renal disorders (polycystic kidneys, renal tubular acidosis) and inborn errors of metabolism. Necrotizing enterocolitis, bowel perforation and gangrene are some common surgical causes of neonatal metabolic acidosis. The small bowel, ileum (30% -50%) is the most common site of duplication cysts [2]. A ruptured non-communicating, acid secreting ileal duplication cyst presenting with metabolic acidosis has not been reported, to the best of authors’ knowledge.
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