CASES OF THE WEEK – “Rare case of male baby with Down syndrome & duodenal atresia (antenatal finding) & operated at 26 hours of life” by Dr Wissam AlTamr, Specialist Paediatric Surgery

Rare case of male baby with Down syndrome & duodenal atresia (antenatal finding) & operated at 26 hours of life.

36 year old pregnant mother under the care of Dr Mona Azmy, Specialist Obstetrics & Gynecologist had her 1st trimester scan which revealed that the baby would have Down’s syndrome. This was confirmed later by a cell free fetal DNA test. In her 3rd trimester scan by Dr Hermann Ulrich, Consultant Obstetrics & Gynecology, he found associated anomalies of Polyhydramnios, Duodenal atresia and suspicion of cardiac anomaly.

The case was discussed with Pediatric surgeon Dr Wissam Altamr, Dr Mona Azmy , the anesthesia team of Dr Ayman & Dr Hazem and Specialist Neonatologist Dr Pooja Agrawal for feasibility of neonatal and surgical management and follow up. All agreed upon to deliver the baby in our hospital and the plan for management was drawn 1 month prior to the delivery date. Upon discussion with the parents about the surgery and the parents were confident about the team and approved for the plan.

Baby was delivered full term by LSCS (Ind. - Previous LSCS). NG was passed at birth and 35ml aspirate was drained. Baby had some tachypnea and was shifted to NICU for further care by Dr Pooja. In the NICU, Dr Wissam was consulted to confirm the diagnosis and also to prepare for surgery. Abdomen x-ray was done: there is double bubble sign and the diagnosis confirm, PICC line was placed for TPN and fluid management. Cardiac ECHO was done by (Dr Ahmed Al Kamali) and baby was found to have small PDA and PFO with mild pulmonary hypertension and was given cardiac approval for surgery.

Baby underwent surgery at 26 hours of life. The surgery was conducted by the Paediatric Surgeon, Dr Wissam Altamr and anesthesia by Dr Ayman & the OT team. During the surgery I found very rare case of duodenal atresia because annular pancreas and mid gut malrotation.  Diamond anastomosis was done side to side duodenal anastomosis for the doudenal atresia and ladd procedure was done for the malrotation. The patient tolerated the procedure, and extubated then shifted to NICU.

In the NICU the baby received TPN for 10 days. He passed stool 2 days after surgery, NG feeds were started on POD 6 which were increased gradually as per tolerance. Baby accepted full oral feeds from POD14 and was discharged in another 2 days.

Baby is yet to come for follow up. He is doing well, gaining weight, and passing stool normally, and the parents were satisfied with the result.

I would like to thank the entire team who made this possible Dr Mona Azmy (Specialist Obstetrics & Gynecologist, Dr Hermann Ulrich, Consultant Obstetrics & Gynecology (IVF), Dr Hazem Daaji, Dr Ayman Hassan, OT Team, Dr Pooja Agrawal-Specialist Neonatologist, Ahmed Al Kamali -Pediatric cardiology consultant, Dr. Loai Eid-Consultant Paediatric Nephrologist, Pediatric RMO’s, Dr Dena Mohamed, Dr Dena Samer Specialist Radiology and the NICU team.