MyPACS.net: Radiology Teaching Files > Case 432408

never visited COLONIC ATRESIA
Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
History: Newborn with abdominal distension. Hispanic male born at term. Initially was sent home on second day of life, having only small amount of meconium passed per rectum . Returned on DOL #5 with disinterest in feeds, vomiting, and obstipation and mild abdominal distention on exam without evidence of sepsis.
Images:[small]larger

Fig. 1: Water soluble enema shows microcolon, unable to get contrast proximal to mid Transverse colon consistent with a colonic atresia.

Fig. 2: At OR, type 3 colonic atresia at mid T-colon with massive ascending colon.

Fig. 3
Findings:

BE shows microcolon, unable to get contrast proximal to mid T-colon consistent with a colonic atresia.

At OR, type 3 colonic atresia at mid T-colon with massive ascending colon. IC valve competent, so that distal ileum only mildly dilated, hence only mild distention on PE. Performed right hemicolectomy, since size match between T-colon and distal ileum more comparable. Did end to side anastamosis. Did well post-operatively , fed about POD #4, DC'd home about POD #5.

Diagnosis: Colonic atresia
Discussion:

Congenital anomalies of the gastrointestinal tract are a significant cause of morbidity in children and, less frequently, in adults. These abnormalities include developmental obstructive defects of the small intestine, anomalies of the colon, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. Neonates with complete high intestinal obstruction do not usually require further radiologic evaluation following radiography, whereas those with complete low obstruction should undergo a contrast material enema examination. An upper gastrointestinal series must be performed in all patients with incomplete intestinal obstruction because management is different in each case. In low intestinal obstruction, ultrasonography (US) may help differentiate between small bowel obstruction and colonic obstruction. In addition, US can help correctly identify meconium ileus and meconium peritonitis and is useful in the diagnosis of enteric duplication cysts. In malrotation and anorectal anomalies, computed tomography (CT) and magnetic resonance (MR) imaging can provide superb anatomic detail and added diagnostic specificity. Intestinal duplications manifest as an abdominal mass at radiography, contrast enema examination, or US. At CT, most duplications manifest as smoothly rounded, fluid-filled cysts or tubular structures with thin, slightly enhancing walls. At MR imaging, the intracystic fluid has heterogeneous signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weighted images. Familiarity with these gastrointestinal abnormalities is essential for correct diagnosis and appropriate management.

References:

Berrocal T, Lamas M, Gutieerrez J, Torres I, Prieto C, del Hoyo ML. Congenital anomalies of the small intestine, colon, and rectum.
Radiographics. 1999 Sep-Oct;19(5):1219-36.
Radiographics / "Radiology Journal"

Mark Saxton, Pediatric surgeon, Omaha Children's Hospital
Phillip Silberberg, M.D. Pediatric Radiologist, Omaha Children's Hospital
Dr. Chad Eicher, M.D. Radiology Resident, Creighton University Medical Center
Benjamin Silberberg

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Additional Details:

Case Number: 432408Last Updated: 04-27-2005
Anatomy: Gastrointestinal (GI)   Pathology: Congenital
Modality: GIExam Date: 01-01-1985Access Level: Readable by all users
Keywords: colonic atresia

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