Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 May 16:2014:bcr2014204171.
doi: 10.1136/bcr-2014-204171.

Trilogy of foregut, midgut and hindgut atresias presenting in reverse order

Ramnik V Patel  1 , Paul Jackson  2 , Paolo De Coppi  2 , Agostino Pierro  2
Affiliations
Case Reports

Trilogy of foregut, midgut and hindgut atresias presenting in reverse order

Ramnik V Patel et al. BMJ Case Rep. .

Abstract

We present a case of triple gut atresias (foregut, midgut and hindgut) with multiple congenital anomalies presenting as imperforate anus. Abdominal radiography showed the double bubble sign. Upper gastrointestinal study through a nasogastric tube confirmed duodenal obstruction. Exploratory laparotomy, duodeno-duodenostomy for duodenal atresia and a left descending colostomy for anorectal malformation were performed. During extubation, the nasogastric tube came out and could not be reinserted by the anaesthetic team under laryngoscopic guidance. A chest radiograph showed the tube curled in the upper pouch. Bronchoscopy and oesophagoscopy confirmed oesophageal atresia (OA) with a distal tracheoesophageal fistula (TOF). The patient underwent right-sided extrapleural thoracotomy and division of the fistula with primary repair of OA uneventfully. Triple gut atresias presenting in reverse order with multiple anomalies is rare and passage of a nasogastric tube into the stomach in the presence of OA+TOF is exceptional. Alimentary tract obstruction should be corrected in proximal to distal direction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Chest and abdominal radiographs. Note the nasogastric tube (NGT), proximal pouch shadow and small gastric air bubble with the rest of the abdomen gasless.
Figure 2
Figure 2
Upper gastrointestinal contrast study showing complete duodenal obstruction beyond the duodenal cap. NGT, nasogastric tube.
See this image and copyright information in PMC

References

    1. Patel RV, Kumar H, More B, et al. Trilogy of foregut atresia without genetic abnormality–exception to the Martinez-Frias syndrome BMJ Case Rep 2014. 10.1136/bcr-2013-200477 - DOI - PMC - PubMed
    1. Patel RV, Kumar H, More B, et al. Situs inversus totalis (SIT), oesophageal atresia (OA) and tracheooesophageal fistula (TOF). BMJ Case Rep. Published Online 3 June 2013. 10.1136/bcr-2013-009955 - DOI - PubMed
    1. Patel RV, Greene O, Motiwale S, et al. The combination of pure oesophageal atresia with an associated missed H-type tracheo-oesophageal fistula. BMJ Case Rep. Published Online 29 July 2013. 10.1136/bcr-2013-200198 - DOI - PMC - PubMed
    1. Patel RV, Jackson PB, De Coppi P, et al. Exclusion of oesophageal atresia by passage of a nasogastric tube: an exception to the rule. BMJ Case Rep 2013. 10.1136/bcr-2013-201175 - DOI - PMC - PubMed
    1. Pamiejer CR, Hubbard AM, Coleman B, et al. Combined pure esophageal atresia, duodenal atresia, biliary atresia, and pancreatic ductal atresia: prenatal diagnostic features and review of the literature. J Pediatric Surg 2000;35:745–7. - PubMed

Publication types

MeSH terms

Supplementary concepts