Closed loop foregut obstruction in a premature neonate

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Abstract

Multiple foregut atresias are exceedingly rare. We present a unique case of combined pyloric and duodenal atresia in a premature neonate. The anomaly appeared to evolve into a closed loop foregut obstruction in the postnatal period. Foregut continuity was established with a gastroduodenostomy, duodenoduodenostomy, and duodenal tapering. The child survived and continued to thrive at 2 years of age.

Section snippets

Case report

A premature baby girl, delivered at 27 weeks' gestation, weighing 862 g, was transferred to our neonatal intensive care unit on the first day of life. The patient was born to a 19-year-old, G2P1A1 mother with a history of polyhydramnios, preterm labor, and prolonged premature rupture of membranes. Fetal ultrasound had demonstrated a double bubble. The mother was delivered by cesarean section for a footling breech. Apgar scores were 8 and 9, at 1 and 5 minutes, respectively. The baby was

Discussion

Haller and Cahill [10] published the first report of combined obstruction of the stomach and duodenum. Interestingly, that patient was initially incorrectly diagnosed with duodenal obstruction only and underwent a second laparotomy for repair of the pyloric atresia [10]. A hereditary form of multiple atresia, starting in the foregut and involving the entire gastrointestinal tract, was first reported by Guttman et al [12] in 1973 and more recently reviewed by Lambrecht and Kluth [13]. In the

Acknowledgment

Ms Chen was supported by a summer research grant from the Department of Surgery, University of California Irvine School of Medicine.

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