A Rare Case of Duodenal Atresia with Situs Inversus Abdominalis

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.