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Case Reports: Unusual association of diseases/symptoms
Delayed finding of congenital duodenal obstruction following congenital diaphragmatic hernia repair
  1. George S Bethell1,2,
  2. Dina Fouad1,
  3. Enitan Ogundipe3 and
  4. Mohammed Choudhry1
  1. 1Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2University Surgery Unit, University of Southampton, Southampton, UK
  3. 3Department of Neonatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to George S Bethell; gbethell{at}doctors.org.uk

Abstract

Congenital diaphragmatic hernia (CDH) is encountered in just under 1 in 6000 live births, while congenital duodenal obstruction is seen once every 8000 live births. These congenital anomalies have only been reported together as part of the VACTERL syndrome and therefore in isolation represent an incredibly rare occurrence. This is a case report of a girl born at 34 weeks gestation who had an antenatal diagnosis of left CDH. Five days following operative repair of this, there was extensive pneumoperitoneum and pneumothorax. Upper gastrointestinal contrast study showed a perforation of the duodenum and at laparotomy, a duodenal web was found in the fourth part of the duodenum with perforation immediately proximal. Following duodenoduodenostomy, the postoperative recovery was good. She achieved full enteral feeds and was discharged home. This case highlights the importance of considering rare associations if postoperative recovery is not as expected to prevent delay in undergoing definitive treatment.

  • paediatric surgery
  • congenital disorders

https://doi.org/10.1136/bcr-2022-253394

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    Footnotes

    • Twitter @gbethellUK

    • Contributors GB designed the case report and acquired the figures. GB drafted the manuscript. DF, EO and MC revised the manuscript. All authors approved this final version. MC has overall accountability for the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.