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Duplication cyst with midgut volvulus in a neonate: an unusual presentation

Nitin G Pai1, Santosh Prabhu2, Pavithra Prabhakar3

  • 1Department of Paediatric Surgery, Kasturba Medical College, Manipal, India.

BMJ Case Reports
|August 28, 2020
PubMed

Insights

Neonatal malrotation with midgut volvulus, a cause of bilious vomiting, can rarely occur with gastrointestinal duplication cysts. Prompt surgical intervention, like Ladd's procedure, is crucial for these rare congenital anomalies.

Area of Science:

  • Pediatric Surgery
  • Congenital Anomalies
  • Neonatal Care

Background:

  • Malrotation of the gut, occurring in 4% of the population, predisposes neonates to midgut volvulus due to a narrow mesenteric base, necessitating urgent surgical intervention.
  • Associated anomalies with malrotation include duodenal obstruction, internal hernias, and Hirschsprung's disease.
  • Gastrointestinal duplication cysts have an incidence of 1:4500.

Observation:

  • A 4-day-old neonate presented with symptoms indicative of intestinal malrotation and reverse volvulus.
  • The neonate also had a rare associated gastrointestinal duplication cyst, a condition with limited reported cases.

Findings:

  • Imaging studies, including ultrasound and contrast radiography, confirmed the diagnosis of malrotation with reverse volvulus and a jejunal duplication cyst.
  • The patient underwent prompt surgical management.

Implications:

  • This case highlights the rare but critical association of malrotation with gastrointestinal duplication cysts in neonates.
  • Surgical intervention, specifically Ladd's procedure combined with resection and anastomosis of the duplication cyst, proved effective in managing this complex congenital condition.

Keywords:
congenital disordersneonatal and paediatric intensive careneonatal healthpaediatric surgerypathology

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