Abstract
We report a rare case of incomplete congenital duodenal obstruction (Type 1 duodenal atresia) in association with situs inversus totalis presenting with gastric perforation in a neonate. The infantogram was suggestive of perforation with air under diaphragm along with dextrocardia. On exploration, a pin point perforation at fundus near lesser curvature along with situs inversus was noted. Primary closure of gastric perforation was done. Patient was then discharged on full breast feeds but was readmitted with intolerance to feeds and recurrent bilious vomiting. Further, upper GI contrast study revealed partial duodenal obstruction. On re-exploration, duodenal web with central aperture was seen and duodeno-duodenostomy was done.
Highlights
Congenital duodenal obstruction presenting as gastric perforation has been reported in only 13 cases in literature.[2,3]
The association of situs inversus with congenital duodenal obstruction has been reported in about 20 cases in literature so far.[1]
Gastric perforation complicating congenital duodenal obstruction makes preoperative diagnosis difficult. The intestinal obstructions such as duodenal atresia, pyloric atresia, malrotation and annular pancreas are seldom the causes of neonatal gastric perforation, it should be explored during closure of perforation
Summary
A full term 2-day-old female neonate with birth weight 2 kg, born by normal vaginal delivery was referred with history of abdominal distension and recurrent bilious vomiting. The child had not passed meconium and had continuous bilious nasogastric aspirates. A pin point gastric perforation at fundus near lesser curvature was noted along with situs inversus. Primary two layered closure of gastric perforation was done along with straightening of duodenum and widening of mesentery.
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