WOFAPS 2025 8th World Congress of Pediatric Surgery

dimelsa luciana porras serna, Lorena Rojas Gonzalez, Pierina Rodriguez Gambetta

Sergio E. Bernales hospital

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Introduction

Intestinal atresias are rare entities. The incidence of ileocolic atresia is 1 in 5,000 to 10,000 live births, the appendiceal duplication the incidence is 0.004% to 0.009% and is associated with other anomalies of the digestive and genitourinary tract. Less than 100 cases of Appendiceal Duplication have been reported since 1902.

Case report

Two-day-old male newborn born by caesarean section due to fetal distress was referred for abdominal distension due to necrotizing enterocolitis, sepsis and probable syphilis. The physical examination found abdominal distension with an absence of hydroaerial noises. The X-ray of the abdomen showed pneumoperitoneum, the associated lab work (CBC) indicated leukocytosis, severe thrombocytopenia, high potassium. During surgery a greenish and purulent fluid was found, dilated distal ileum with necrosis and a blind pouch: subseral cecal appendix with coprolite inside (Figure 1), collapsed colon, suppurated cecum with necrotized blind pouch with fibrin (Figure 2), the dilated distal ileum is resected with cecal appendix. The cecum and blind pouch are resected. (Figure 3), an ileostomy and colostomy are performed with mucous fistula. The Patient had infection by Klebsiella and pseudomonas, was discharged at one month of life and was transferred to a more specialized hospital for severe dehydration, after colon irrigations, the intestinal tract was restored without major complication, oral nutrition was resumed 3 days after surgery and patient was discharged later.

Figure 1: Perforated terminal ileum with cecal appendix Figure 2: intestine with cecal appendix and blind sack

Figure 3: ileocolic atresia

Figure 4: cecal appendix 1 Figure 5: distal ileum and cecum with appendix and blind sack

Conclusion

This is an extremely rare pathology, the surgery should be performed immediately after diagnosis or suspicion of obstruction to prevent further complications such as sepsis, and also to provide irrigation in the distal segment.