Colonic atresia

Case contributed by Dr Jacob Whitworth

Presentation

Failure to pass meconium, abdominal distension and currently vomiting.

Patient Data

Age: 2 days
Gender: Male
X-ray

Correctly sited NG tube. 

Dilated bowel loops, but no pneumatosis or pneumoperitoneum. 

No gas within the rectum.

Ultrasound

Ultrasound showed dilated bowel loops with a small amount of interloop free fluid. 

The rest of the abdominal ultrasound was unremarkable. 

Fluoroscopy

Contrast was introduced into the rectum via a catheter. No contrast passed proximal to the sigmoid colon, and there was a abnormal tapering of the colon in the mid-sigmoid. No plugs were seen in the distal large bowel. 

Despite multiple attempts to opacify the proximal large bowel, there was constant leakage of contrast and no proximal opacification. 

An upper GI contrast study was performed at the same time and was normal. 

At theater the patient had a short segment atresia involving the distal descending and sigmoid colon. The segment was resected with an end to end anastomosis and de-functioning ileostomy. This was successfully reversed 6 weeks later. 

Case Discussion

Colonic atresia is a rare cause for failure to pass meconium, and a rare site for an atresia in the GI tract (esophagus, ileum and duodenum are all more common). 

The diagnosis was suspected following the barium enema, but not certain without the surgical findings. The enema appearances could potentially have represented a stricture or large plug. 

At theater the patient had a short segment atresia involving the distal descending and sigmoid colon. The segment was resected with an end to end anastomosis and de-functioning ileostomy. The ileostomy was successfully reversed 6 weeks later, and the patient recovered well. 

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