Imperforate Anus with Jejunal Atresia Complicated by Intestinal Volvulus: A Case Report

Type 4 Ileal Atresia and Anorectal Malformation in a Neonate: A Rare Association

Anorectal malformations and jejunoileal atresias are common causes of intestinal obstruction in neonates. Both have their own set of associated anomalies but it is extremely rare for the two to co-occur in the same patient. In this case report, we detail and describe this unusual incidence in a three-day-old neonate who was provisionally diagnosed with a case of simple imperforate anus. Per-op findings showed a type 4 Ileal atresia and an ileostomy was then created. Our experience stresses the importance of timely antenatal diagnosis and the presence of a high index of suspicion when encountering such patients. Both factors are key and crucial in determining the outcome and post-op course of the patient.

Rare case report of anorectal malformation and intestinal atresia

Introduction

Intestinal malformations, such as intestinal atresia, malrotation, and anorectal malformation, are rare events, but concurrent intestinal atresia and anorectal malformation are rare in combination. These anomalies have similar in utero and perinatal symptoms, which can make the diagnosis of both defects prenatally challenging.

Presentation of case

We present a case of a male infant with a prenatal diagnosis of truncus arteriosus who on a 32-week routine prenatal ultrasound was suspected to have an intestinal malformation. On day of life one, the patient was taken to the operating room and found to have both type IIIa ileal atresia and anorectal malformation with normal bowel in between. A complete work up for vertebral defects, anorectal malformation, cardiac septal defects, esophageal atresia, renal anomalies, and radial limb defects (VACTERL) anomalies did not reveal additional anomalies.

Discussion

In this case, prenatal information supported intestinal obstruction, and the rare combination of both intestinal atresia and anorectal malformation proved surprising and interesting.

Conclusion

We suggest providers be aware of the potential of multiple alimentary tract malformations to improve operative preparation and reduce the morbidity or mortality risk from repeat procedures when possible.

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The combination of anorectal malformation and intestinal atresia is exceedingly rare.

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This unique combination was found in a twin with the other twin having a normal intestinal tract.

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A VACTERL workup is key to rule out other malformations.