Distal Ileal Atresia in a Preterm Infant with Minor Omphalocele: A Case Report

Omphalocele is a congenital abdominal wall defect that is characterized by herniation of the abdominal viscera through the umbilical ring. Compared with gastroschisis, omphalocele is less frequently associated with ileal atresia. This report describes a preterm newborn with a minor omphalocele complicated by ileal atresia, a complication that may have been previously underestimated.

A 5-day-old preterm male infant (gestational age 34 weeks, birth weight 2005 g) presented with delayed meconium passage and persistent bilious gastric aspirates. Antenatal ultrasound revealed an umbilical cyst without any other anomalies. On day 4, a gastrointestinal series examination revealed dilated small bowel loops and a small-caliber colon. Surgical exploration revealed bowel contents entrapped within a 2.2-cm minor omphalocele. The infant was diagnosed with type IIIa distal ileal atresia and colonic atresia, and end-to-end anastomosis was performed. The patient was discharged at a corrected age of 6 weeks on a hypoallergenic semi-elemental formula (50 mL per meal) and partial parenteral nutrition. He was successfully weaned off parenteral nutrition by a corrected age of approximately 10 months. His weight gain was stable, although it remained at approximately the 3rd percentile, and no obvious neurodevelopmental complications were observed.

This case highlights the importance of recognizing that even minor omphaloceles can be associated with ileal atresia. In neonates with minor omphaloceles, symptoms of feeding intolerance should prompt consideration of this complication.