partial situs abdominus with partial duodenal obstruction
Post on 04-Apr-2018
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HAYSSAM RASHWAN
PEDIATRIC SURGERY
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An 10-day-old male, who weighed 3 kg onpresentation, was admitted for biliousvomiting since the age of 3 days. Parentsreport a rarefaction of stool. No antenatalultrasound available.
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Physical examination: Lax ,non distended abdomen
Greenish vomitus
Normal placed apex beat on left side Liver palpated on right side
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Radiography: Plain X ray revealed dilated stomach with
deviation of the nasogatric to the right.
Gastrographin study revealed dilated rightsided stomach and left sided duodenum withpassage of dye in delayed film.
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stomachduodenum
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The intraoperative findings consisted ofduodenal obstruction due to incompleteintraluminal diaphragm of duodeno-jejunal
junction; right sided liver; right sided
polysplenia and stomach . Multiple spleenswere found along greater curvature.
Normally situated colon with right sided caecumand no malrotation detected.
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stomach
Caecu
m
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polysplenia
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diaphragm
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Postoperative course was uneventful; thepatient tolerated breastfeeds fourth daypostoperative was discharged five days aftersurgery.
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DD: SITUS INVERSUS TOTALIS
MOMS
DEXTROGASTRIA SITUS INVERSUS PARTIALIS (HETEROTAXIA)
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Combination of partial situs inversus,polysplenia with duodenal obstruction.
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Abdominal situs inversus carries a significantmortality because the majority of cases (95 %)have associated cardiac and splenic defects.
A review of all cases reported in the Englishliterature confirms in addition the presence ofsignificant gastro-intestinal pathologies,mainly annular pancreas, midgut volvulusand duodenal atresia.
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We report on an additional case ofabdominal situs inversus without cardiacabnormality, who had partial duodenalobstruction secondary to a mucosal
diaphragm.
This seems to be the fourteenth caseassociated with duodenal obstruction and theseventh case secondary to amucosal duodenal diaphragm, to date, in thissetting.
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To be continued
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