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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