Congenital Anomaly Of Gastrointestinal Tract Research Articles

Predictive Ability of Ultrasound on Neonatal Diagnoses and Consequences on Prenatal Care Utilization.

Fetal anomalies suspected on fetal ultrasound may cause significant stress for patients. Some findings resolve or have minimal clinical significance for the neonate. Our purpose is to evaluate fetal ultrasound accuracy and false-positive results and determine the clinical impact on maternal counseling. A retrospective review was performed on electronic medical records for women receiving prenatal care at Harbor-UCLA Medical Center who had abnormal findings on fetal ultrasounds between January 2015 and December 2018. Corresponding neonatal medical records were reviewed for the suspected condition(s). χ2 and Fisher exact tests were conducted to assess associations between fetal ultrasounds and neonatal outcomes. Two hundred eight mothers and 237 babies (including all 29 sets of twins) were included in the final analysis. Fetal ultrasounds were significantly associated with neonatal findings for the following conditions (sensitivity, specificity): anatomical disorder of extremities (0.72, 0.97), anatomical disorder of the face/skull/brain (0.67, 0.91), congenital anomaly of gastrointestinal tract (0.75, 0.98), congenital heart disease (0.75, 0.91), genetic disorder (0.72, 1.00), growth restriction (1.00, 0.85), kidney disorder (0.55, 0.98), and large for gestational age (0.80, 0.98). The highest false-positive rates occurred in congenital heart disease (65.4%), anatomical disorder of the face/skull/brain (64.3%), and growth restriction (54%). Fetal ultrasound highly correlates with neonatal findings for many congenital conditions. However, it can also be associated with a high false-positive rate for certain diagnoses; maternal counseling should include the limitations of ultrasound, including the potential for false-positive results.

MECKELS DIVERTICULUM WITH MESENTERY AS A RARE CAUSE OF CLOSED LOOP OBSTRUCTION-A CASE REPORT

Meckel's Diverticulum is most common congenital anomaly of gastrointestinal tract. It arises from Antimesenteric border of the small bowel [1]. In contradiction, a case encountered at our institution where a 32-y old female presented with complaints of pain abdomen since 3 days, vomiting's since 3 days, obstipation since 3 days and distention since 1 day. On examination abdomen is distended, diffuse tenderness present all over the abdomen with no bowel sounds and collapsed rectum with no fecal staining per rectally. Imaging studies on ultra-sonography shown dilated small bowel loops with max diameter of 3.1cm showing to and fro peristalsis. On CT abdomen multiple dilated small bowel loops with air uid levels with maximum diameter of 4.1cms with collapsed terminal ileum and large bowel. ?Closed Loop Obstruction. Emergency exploratory laparotomy was planned and shown Meckel's diverticulum with mesentery present on anti-mesenteric border with mesentery extending from mesenteric border to tip of Meckel's diverticulum with internal herniation of proximal ileum between the Meckel's and its mesentery causing closed loop obstruction noted at 60cms from IC junction for which herniated bowel loops was released with diverticulectomy followed by anastomoses of proximal and distal ileal loops. Resected Meckel's sent for histopathological examination and cut section showed mucosa, sub-mucosa, muscularis propria and serosa. Mucosa shows chronic nonspecic inammation, sections from the adjacent area's shows hyperplastic mucosa, hypertrophied muscularis layers and serosa with congested blood vessels with feature's consistent with Meckel's diverticulum. Patient was followed for 6 months, and the course was un-eventful.

Frequency and Pattern of GIT Anomalies in Neonates: A Retrospective Study at NICU Mayo Hospital Lahore

Aim: To acknowledge magnitude and spectrum of congenital anomalies of gastrointestinal tract in neonates and to establish possible factors resulting in these congenital anomalies. Material And Methods: The design of this study was Retrospective observational study. This study was conducted at NICU department of pediatric surgery King Edward medical university / Mayo hospital Lahore from June 2021 to May 2022. Neonates admitted in NICU department of pediatric surgery with gastrointestinal congenital anomaly were included in this study. Neonates having congenital anomaly other than GIT were excluded. Patient information regarding diagnosis and possible cause of congenital anomaly was noted on prescribed proforma. Results: During the study period total 256 neonates were admitted in neonatal ICU department of pediatric surgery Mayo hospital Lahore. Out of these 156(60.9%) neonates were having congenital anomalies of gastrointestinal tract while reaming 100(39.1%) neonates were having congenital anomalies of other structures. Most common congenital anomaly of GIT was anorectal malformations 35(22.4%) followed by Intestinal atresia’s in 30(19.2%). Conclusion: Congenital anomalies play an important role in neonatal mortality rate of any developing country like Pakistan. Chromosomal disorders, environmental and infectious factors are major contributing factors. Gastrointestinal tract anomalies are the most common anomalies of neonates with predominance of anorectal malformations. Antenatal care and timely interventions can reduce frequency of these anomalies. Keywords: Congenital anomalies, gastrointestinal tract, pattern.

CASE REPORT : RARE CASE OF SMALL BOWEL OBSTRUCTION DUE TO MECKELS DIVERTICULUM

Meckels diverticulum is a rare congenital anomaly of gastrointestinal tract, seen in 2% of population. It was first described by Guilhemus Fabricus Hildonus in 1598. Meckels diverticulum is an anomaly derived from incomplete obliteration of omphalo-mesenteric duct. It is rarely seen in adults, with prevalence of male to female of 2:1. Complications associated with Meckels diverticulum are hemorrhage, inflammation and intestinal obstruction. We present to you a case of 17 year old male with unusual mechanism of small bowel obstruction due to Meckels diverticulum.

Evolution of Resting Energy Expenditure, Respiratory Quotient, and Adiposity in Infants Recovering from Corrective Surgery of Major Congenital Gastrointestinal Tract Anomalies: A Cohort Study.

This cohort study describes the evolution of resting energy expenditure (REE), respiratory quotient (RQ), and adiposity in infants recovering from corrective surgery of major congenital gastrointestinal tract anomalies. Energy and macronutrient intakes were assessed. The REE and RQ were assessed by indirect calorimetry, and fat mass index (FMI) was assessed by air displacement plethysmography. Longitudinal variations over time are described. Explanatory models for REE, RQ, and adiposity were obtained by multiple linear regression analysis. Twenty-nine infants were included, 15 born preterm and 14 at term, with median gestational age of 35.3 and 38.1 weeks and birth weight of 2304 g and 2935 g, respectively. In preterm infants, median REE varied between 55.7 and 67.4 Kcal/kg/d and median RQ increased from 0.70 to 0.86–0.92. In term infants, median REE varied between 57.3 and 67.9 Kcal/kg/d and median RQ increased from 0.63 to 0.84–0.88. Weight gain velocity was slower in term than preterm infants. FMI, assessed in a subset of 15 infants, varied between a median of 1.7 and 1.8 kg/m2 at term age. This low adiposity may be related to poor energy balance, low fat intakes, and low RQ¸ that were frequently recorded in several follow-up periods.

Lower Gastrointestinal Bleeding Caused by Meckel’s Diverticulum

Meckel’s diverticulum is a congenital anomaly of gastrointestinal tract with an incidence of 2% in the general population. It occurs due to the persistence of omphalomesenteric duct during embryonic period of life. It may be asymptomatic or can manifest as intestinal obstruction or massive lower GI bleeding. It usually presents before the age of 2 years and may contain ectopic tissue. Here, we are reporting a case of 7-year-old child with Meckel’s diverticulum presenting as painless bleeding per rectum and anemia.

Antenatal predictors of intestinal pathologies in fetal bowel dilatation.

Fetal bowel dilatation (FBD) in the late trimester of pregnancy can be related with varies of prognosis. Our aims were to obtain antenatal factors that might have relevance for the distinct prognosis with FBD. Seven features of 68 pregnancies presented with FBD were assessed. The best cut-off value to predict intestinal outcomes was selected using receiver-operating characteristics curves, and the effective variables were included into a logistic regression model. The best cut-off valves to predict intestinal pathologies were 14.5 mm of fetus dilated loop and 37.7 weeks of gestational age at delivery, respectively. The congenital gastrointestinal tract anomalies included 24 cases (92.3%) of intestine atresia, 1 case (3.85%) of small intestine volvulus and 1 case (3.85%) of midgut malrotation. Fetal dilated loops and gestational age at delivery are both an independent risk factor for predicting intestinal pathologies of newborns, which should arouse high attention.

Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum

Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice.

Goldenhar Syndrome associated with Vestibular Fistula and Esophageal Atresia – A Rare Association

Goldenhar syndrome is associated with various other congenital anomalies of gastro-intestinal tract, heart, kidney and genitourinary system. We report a rare association of Goldenhar syndrome with vestibular fistula and esophageal atresia.

A prenatally diagnosed gastric duplication cyst connecting the pancreatic duct and paraspinal region

The gastrointestinal duplication of stomach is uncommon congenital anomalies of gastrointestinal tract. Herein a rare case of gastric duplication with newborn is being reported. A 14-day-old term female baby was admitted to our clinic with intermittent bilious vomiting and abdominal distention. In evaluation, abdominal cystic mass was detected in the left upper quadrant. The cyst which was attached to both the pancreatic duct and spinal cord was removed totally by laparotomy. A histologic examination showed gastric duplication cyst. The postoperative course was uneventful. There were no any complications at the 8-month follow-up period. This rare entity should be included in the differential diagnosis of cystic masses of the gastrointestinal tract and treated surgically by complete resection due to the risk of malignant transformation and other complications. This is the first case report that the gastric duplication cyst has a connection with both the pancreatic duct and spinal cord.

Value of ultrasonic diagnosis and analysis of missed diagnosis and misdiagnosis for neonatal annular pancreas

Objective To investigate the clinical value of ultrasonic diagnosis for neonatal annular pancreas, analyze the reasons of missed diagnosis and misdiagnosis, and improve diagnostic accuracy of ultrasonography for this disease. Methods Clinical data of 98 newborns with annular pancreas confirmed by gastrointestinal contrast and surgery were analyzed retrospectively. Preoperative ultrasonogram were compared with the result of gastrointestinal contrast and surgery. Ultrasound images failed to be correctly dignosed were further studied to summarize diagnostic points for this disease. Results Among the 98 cases, 75 were correctly diagnosed by ultrasound with a diagnostic accordance rate of 76.5%, 18 were missed diagnosed and 5 were misdiagnosed with a total misdiagnosis rate of 23.5%. Ten cases associated with other congenital gastrointestinal tract anomalies were missed diagnosed due to ignoring scanning pancreas. Five cases were missed diagnosed due to obvious intestinal cavity flatulence. Three cases were missed diagnosed due to lack of awareness of the disease. Five cases were misdiagnosed for duodenal stenosis or duodenal atresia. Conclusions Ultrasound has important diagnostic value for neonatal annular pancreas, providing the dignostic evidences for clinical treatment. Thus it can be used as the preferred auxiliary examination of the disease. Since annular pancreas is often accompanied by other gastrointestinal malformations and can be interfered by abdominal gas, missed diagnosis and misdiagnosis occurred easily. To improve the accuracy of ultrasonic diagnosis, all causes of neonatal gastrointestinal tract obstructions should be considered during the examination. Key words: Ultrasonography; Annular pancreas; Neonate; Missed diagnosis

English

INTRODUCTION: Congenital anomalies of gastrointestinal tract occur from oesophagus upto anorectum as a result of abnormal embryogenesis. Specific patterns of malformations of gastrointestinal tract include stenosis and atresia, duplications, abnormal rotation and fixation, abdominal defects and others associated with persistence of embryonic structures (e.g. Meckel's diverticulum), or abnormalities in its cellular components (e.g. nerves in Hirschsprung's disease). These disorders primarily result in symptoms of intestinal obstruction, effects on surrounding structures or of associated anomalies. Early diagnosis is therefore very vital. AIM: To study the clinical presentation, radiological features, gross and histopathology of congenital anomalies of G.I.T. MATERIAL AND METHODS: Surgical specimens collected were sent to the department of pathology for gross and histopathological confirmation of diagnosis. The specimens were processed routinely and H & E stained slides studied. RESULTS: Out of 2996 specimens, 286 were found to be of congenital anomalies of G.I.T. With a sex ratio of 3:1Hirschsprung's disease was commonest 50.34%, Omphalomesenteric duct remnants 16.78%, followed by intestinal atresia 10.13% CONCLUSION: Congenital anomalies of gastrointestinal tract are a cause of significant mortality and Morbidity in paediatric age group. Though radiodiagnosis is the preliminary diagnostic modality, gross and histopathological examinations are essential to confirm the diagnosis.

Gastroschisis, ileal atresia, and Hirschsprung's disease in a newborn: The first reported case

AbstractGastroschisis and intestinal atresia are rare congenital gastrointestinal tract anomalies that coincide with each other in 5%–15% of cases. In contrast, there are only two reported cases of Hirschsprung's with simultaneous gastroschisis. We report the first case of gastroschisis, ileal atresia, and Hirschsprung's disease in a newborn. Despite the high morbidity and mortality associated with simultaneous congenital gastrointestinal tract anomalies, surgical management of these patients is feasible.

Ultrasonic and clinical aspects in the diagnosis and prognosis of congenital gastrointestinal anomalies.

The diagnostic and prognostic aspects were analyzed in 36 cases of congenital gastrointestinal tract anomalies. An abnormality was ultrasonically detected or strongly suspected in 53% of the cases, with the highest accuracy in the groups of omphalocele and duodenal atresia and with the lowest detection rate in diaphragmatic hernia and oesophageal atresia. Polyhydramnion was present in 47% of the cases. The high rate of total fetal and neonatal loss (70%) was mainly attributed to associated multiple anomalies of the fetus (66%). The frequency of chromosomal abnormalities was 39%. Our results reflect the complexity of the practical problems associated with the diagnosis and management of fetal gastrointestinal anomalies.

Congenital heart disease associated with congenital gastrointestinal tract anomalies : T. Akasaka, K. Itoh, N. Kohguchi, Y. Ohkawa, A. Tsunoda, T. Nishi, R. Yamada, and R. Matsuoka. J Jap Soc Pediatr Surg 13:403–412 (April), 1977

Congenital heart disease associated with congenital gastrointestinal tract anomalies : T. Akasaka, K. Itoh, N. Kohguchi, Y. Ohkawa, A. Tsunoda, T. Nishi, R. Yamada, and R. Matsuoka. J Jap Soc Pediatr Surg 13:403–412 (April), 1977

Congenital Heart Diseases combined with Congenital Gastrointestinal Tract Anomalies : Report of 3 cases surgically treated for both CHD and GI Tract anomalies

Congenital Heart Diseases combined with Congenital Gastrointestinal Tract Anomalies : Report of 3 cases surgically treated for both CHD and GI Tract anomalies