March 2025, Volume 3, Issue 3

Author

Dhruv Jodha Dodiya, Sanjeev Agarwal, Dhruv Mahajan, Mit Patel and Sunil Patel

Abstract

The synchronous association of bowel atresia, intestinal malrotation, and anorectal malformation is rarely seen. Such neonates possess an embryologic, diagnostic, and therapeutic dilemma. Preoperative diagnosis of one in the presence of the other is seldom possible. The trifecta can be confirmed mostly on the operating table only. Thus, the clinician needs to be aware of the possibility of this combination in the presence of any two of these. A full-term neonate presented with the absence of a normal anal opening and multiple episodes of bilious vomiting. On examination, there was upper abdominal fullness and bilious aspirates from the nasogastric tube. A vestibular fistula was identified on perineal examination. The abdominal radiograph had a paucity of distal bowel gas raising a suspicion of proximal bowel atresia. On laparotomy, jejunal atresia type IIIb and malrotation of the midgut were found. Distal atresias were ruled out. A Ladd's procedure and jejuno-jejunostomy were done. The patient had an unremarkable recovery and posterior sagittal ano-rectoplasty was planned at a later stage. Such rarely described anomalies need to be analyzed to get a better understanding of the etiological and embryological basis of such anomalies. It is important to be cognizant of such an anomaly, in case of the defects are seen preoperatively for better planning and outcome.