HISTORY : Female newborn delivered by LSCS, presented clinically with an absent anal opening and having Down’s syndrome

Physical Examination :Female newborn delivered by LSCS, weighing 2.75kg. Afebrile, Pulse 142/min. RR 42/min, CRT<3 sec, No pallor, no icterus, no edema.APGAR: 1 min-7 and 5 min-8P/A exam. – tense, no T/G/R, abdominal distension.

AUTHORS : Dr. Aditya Ghatnekar. Dr. Pranav Jadhav Dr. Adarsh Hegde Dr. Abhijeet BenareINSTITUTION : DEPT OF PEDIATRIC SURGERY, DY PATIL MEDICAL COLLEGE, PUNE

X Ray abdo erect: Intestinal atresia with grossly dilated bowel loops.

USG A/P: Rt kidney shows mild hydronephrosis with fluid filled transverse colon 2.8 cm in calibre

CASE REPORT : MULTIPLE ATRESIA

Investigations :Hb%-15.7gm% ,TLC-3000/c.mm, P-70,L-20,M-4,E-6,B-0 ,Platelet count-20,000/c.mm, PCV- 49.6%.PBS: normocytic normochromic cells.CRP Quantitative- 1.8 mg/l

Urethral and vaginal opening were distinctly present. An abnormal fistulous tract could not be demonstrated in the perineum. Patient also had clinical features of downs syndrome. Within 12 hours the patient developed abdominal distention with bilious aspirate. Clinical and radiological evaluation mandated an emergency surgical exploration.

Intraoperatively a very rare combination of anomalies was noticed. The patient had jejunal atresia with colonic atresia with rectal atresia. This is a rare combination of anomalies in a patient with downs syndrome with anorectal malformation.

Plan of Management: The patient underwent emergency exploratory laparotomy with atresia repair with colostomy under General Anesthesia and was admitted in the NICU. However, the patient did not survive post operatively. The rarity and mode of presentation makes it an interesting case to be reported.

Jejunal atresia

Operative image