Late Presentation of a Congenital Intrinsic Duodenal Obstruction in a Patient with Anorectal Malformation

Parkash Mandhan, Kirtikumar J. Rathod, Dilip Sankhla

Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman.
Division of Paediatric Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

DOI: 10.4236/ss.2013.47065                

Abstract

Anorectal Malformations are known to be associated with various other congenital anomalies including duodenal atresia. An association of congenital intrinsic duodenal obstruction causing partial duodenal obstruction in a patient with anorectal malformation is not described in literature. We describe a case of delayed presentation of congenital intrinsic duodenal obstruction in a child with high-type anorectal malformations causing diagnostic dilemma.

Keywords

Anorectal Malformations; Duodenal Obstruction; VACTERL Association; Delayed Presentation; Infant

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Pena and M. Levitt, “Anorectal Malformations,” In: J. L. Grosfeld, J. A. O’Neil, E. W. Fonkalsrud, et al., Eds., Text Book of Pediatric Surgery, Mosby Elsevier, Philadelphia, 2006, pp. 1566-1589.
[2]	E. A. Hassink, P. N. Rieu, B. C. Hamel, et al., “Additional Congenital Defects in Anorectal Malformations,” European Journal of Pediatrics, Vol. 155, No. 6, 1996, pp. 477-482. doi:10.1007/BF01955185
[3]	N. Morikawa, T. Kuroda, T. Honna, et al., “A Novel Association of Duodenal Atresia, Malrotation, Segmental Dilatation of the Colon, and Anorectal Malformation,” Pediatric Surgery International, Vol. 25, No. 11, 2009, pp. 1003-1005. doi:10.1007/s00383-009-2459-y
[4]	C. Stoll, Y. Alembik, B. Dott, et al., “Associated Malformations in Patients with Anorectal Anomalies,” European Journal of Medical Genetics, Vol. 50, No. 4, 2007, pp. 281-290. doi:10.1016/j.ejmg.2007.04.002
[5]	A. Beeks, J. Gosche, H. Giles, et al., “Endoscopic Dilation and Partial Resection of a Duodenal Web in an Infant,” Journal of Pediatric Gastroenterology & Nutrition, Vol. 48, No. 3, 2009, pp. 378-381. doi:10.1097/MPG.0b013e31818c600f
[6]	A. Y. Kshirsagar, S. R. Sulhyan, G. Vasisth, et al., “Duodenal Stenosis in a Child,” African Journal of Paediatric Surgery, Vol. 8, No. 1, 2011, pp. 92-94. doi:10.4103/0189-6725.78940
[7]	M. G. Peetsold, S. Ekkelkamp and H. A. Heij, “Late Presentation of a Duodenal Web in a Patient with Situs Inversus and Apple Peel Jejunal Atresia,” Pediatric Surgery International, Vol. 20, No. 4, 2004, pp. 301-303. doi:10.1007/s00383-003-1132-0
[8]	G. R. Boocock and D. Donnai, “Anorectal Malformation: Familial Aspects and Associated Anomalies,” Archives of Disease in Childhood, Vol. 62, No. 6, 1987, pp. 576-579. doi:10.1136/adc.62.6.576
[9]	M. M. Harjai, “Congenital Triple Atresia of the Esophagus, Duodenum and Rectum—A Diagnostic Dilemma,” Medical Journal Armed Forces India, Vol. 56, No. 4, 2000, pp. 334-335.
[10]	R. Niramis, M. Anuntkosol, A. Tongsin, et al., “Influence of Down’s Syndrome on Management and Outcome of Patients with Congenital Intrinsic Duodenal Obstruction,” Journal of Pediatric Surgery, Vol. 45, No. 7, 2010, pp. 1467-1472. doi:10.1016/j.jpedsurg.2010.02.049
[11]	G. V. Smith and R. L. Teele, “Delayed Diagnosis of Duodenal Obstruction in Down Syndrome,” American Journal of Roentgenology, Vol. 134, No. 5, 1980, pp. 937-940. doi:10.2214/ajr.134.5.937
[12]	S. S. Lee, S. T. Hwang, N. G. Jang, et al., “A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife,” Gut and Liver, Vol. 5, No. 1, 2011, pp. 105-109. doi:10.5009/gnl.2011.5.1.105
[13]	P. Mandhan, Q. B. Quan, S. Beasley, et al., “Sonic Hedgehog, BMP4, and Hox Genes in the Development of Anorectal Malformations in Ethylenethiourea-Exposed Fetal Rats,” Journal of Pediatric Surgery, Vol. 41, No. 12, 2006, pp. 2041-2045. doi:10.1016/j.jpedsurg.2006.08.035
[14]	J. Zhang, Z. B. Zhang, H. Gao, et al., “Down-Regulation of SHH/BMP4 Signalling in Human Anorectal Malformations,” Journal of International Medical Research, Vol. 37, No. 6, 2009, pp. 1842-1850. doi:10.1177/147323000903700620
[15]	K. J. Rathod, D. Vaze and K. L. Narasimhan, “Novel Association of Multiple Gastrointestinal Anomalies in a Single Patient: Can Sonic Hedgehog Explain It?” Congenital Anomalies (Kyoto), Vol. 52, No. 1, 2012, pp. 62-63. doi:10.1111/j.1741-4520.2011.00320.x