Abstract:
Background: Duodenal atresia is one of the causes of intestinal obstruction in a new-born. It can be
associated with other congenital anomalies such as intestinal malrotation and congenital heart
diseases. Association of duodenal atresia with situs inversus abdominalis is
extremely rare. It is characterised by bilious or non-bilious vomiting within 24 to 38 hours of neonatal
life, typically following the first oral feeding.
Case Report: A ten hour old male neonate delivered at 37weeks presented with bilious vomiting.
There was polyhydramnios in third trimester. There was no abdominal distension, no meconium
passed at 48hrs, and systemic review was normal. On examination, he was febrile and tachypnoeic.
His naso-gastric tube drained bilious effluent and bowel sounds were absent. He had a grade 3
systolic murmur at the left lower sternal border. A plain abdominal radiograph revealed a reverse
double-bubble sign without dextrocardia. Echocardiography revealed a congenital mitral
incompetence. Based on these findings, diagnosis of duodenal atresia with situs inversus
abdominalis and congenital heart disease was made. The child had a laparotomy with intraoperative
findings of type 3 duodenal atresia, dilated stomach and proximal duodenal
segment, complete situs inversus abdominalis, polysplenia, intestinal malrotation and midgut
volvulus. He had Kimura diamond duodeno-duodenostomy, Ladd’s procedure and a transgastric,
transanastomotic tube was passed. He stooled and breast feeding commenced via transgastric
transanastomotic tube on third and fourth postoperative days respectively. He did well and was
discharged to go home.
Conclusion: It is of utmost importance to look out for congenital anomalies when evaluating
patients with duodenal atresia. This case reiterates the significance of reverse double bubble sign as
an important preoperative means of recognizing this condition.
