MyPACS.net: Radiology Teaching Files > Case 11381141

never visited 1 DAY OLD WITH IMPERFORATE ANUS
Contributed by: Mohamed Eltomey, Radiologist, Tanta University Hospitals-Radiology & Imaging Dept., Egypt.
Patient: 1 day old female
History: A newborn referred from the pediatric surgery unit, routine neonatal check revealed absent anus.
Images:[small]larger

Fig. 1: Prone cross table view of the pelvis showing decreased bowel gas and the 2 gas bubble high in the abdomen (note technichal error in using a large marker on the site of anus, the marker should be as small as possible "BB")

Fig. 2: Upright radiograph of the abdomen and pelvis showing the classical double bubble sign of Duodenal atresia, note also the abnormal shape of the sacrum
Findings: An prone cross table radiograph performed at 12 hours of life to determine the level of the anomaly revelaed a little or scanty gas in the abdomen.
Two gas bubbles were seen high in the abdomen.
An erect Radiograph was performed and revelead a classical double bubble sign of duodenal atresia.
Diagnosis: Duodenal atresia and Imperforate anus "VATER association"
Discussion:

Duodenal obstruction occurs in 1/5000 to 10000 live births, involving male infants more than females. Down syndrome occurs in about one quarter of these patients; congenital heart disease in about 20% of them. Duodenal atresia and stenosis may be part of the VATER association (Vertebral, Anal, TracheoEosphageal and Renal anomalies).

The term imperforate anus encompasses a broad spectrum of anorectal malformations. This is a disorder of embryogenesis involving the hindgut and results from abnormal development of the urorectal septum, with incomplete separation of the cloaca into its urogenital and anorectal components.
References:

Kimura K, Loening-Baucke V: Bilious Vomiting in the newborn: Rapid diagnosis of intestinal obstruction. Am Fam Physician 61:2791-8, 2000.

Ross AJ.: Intestinal obstruction in the newborn. Pediatrics in Review 15(9):338-347,1994.
Comments:
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Additional Details:

Case Number: 11381141Last Updated: 10-20-2007
Anatomy: Gastrointestinal (GI)   Pathology: Congenital
Modality: Conventional RadiographAccess Level: Readable by all users
Keywords: imperforate anus, duodenal atresia

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