Tapering of the Dilated Lesion is Effective for the Segmental Dilatation of the Duodenum: A Neonatal Case Report

Abstract

We herein report the case of a 0-day-old female baby. Fetal ultrasound showed a cardiac anomaly, polyhydramnios and an abdominal mass at 19 weeks of gestation, and hypoplastic left heart syndrome was noted at 24 weeks of gestation. Magnetic resonance imaging showed a cystic mass about 80 mm in diameter between the upper abdominal region and the pelvic space at 28 weeks of gestation. In addition, fetal ultrasound at 33 weeks of gestation showed peristalsis of the dilated intestinal wall. The neonate underwent emergent laparotomy at 0 days of age under suspicion of meconium peritonitis based on her air-fluid level, as abdominal X-ray immediately after birth seemed to indicate intraabdominal free air. Operative findings showed a partially precipitous expansion of the duodenum, which was 10 × 10 × 15 cm in diameter. This lesion was considered to be segmental dilatation of the duodenum. Tapering of the dilated duodenum was performed because the ampulla of Vater was identified on the dilated lesion of the duodenum. Enteral tube feeding was uneventfully initiated after surgery. However, the patient ultimately died of pulmonary hypertension due to hypoplastic left heart syndrome at 78 days of age.