Intestinal Obstruction due to Ileal Duplication Cyst and Malrotation in a Preterm Neonate

The baby was born to a 24-year-old primigravida mother by cesarean section at 36 week gestation and weighed 2420 grams. Antenatal scan at 32 week gestation showed dilated bowel loops and polyhydramnios (Amniotic fluid index: 32 cm) suggestive of intestinal obstruction. He developed respiratory distress soon after birth and was referred to our unit. On examination, the baby had respiratory distress with RR of 72/min. and sub costal retractions. Abdomen was distended at birth and baby had 120 ml of bilious aspirate in the first 14 hours of life. X-ray of abdomen showed dilated proximal bowel loops with absence of gas in distal bowel loops suggestive of intestinal obstruction. A provisional diagnosis of intestinal atresia was made. Laparotomy showed duplication cyst measuring 6 cm in diameter along the antimesenteric border involving proximal ileum and malrotation of small bowel (Fig. 1) Duplication cyst along with adjoining portion of ileum measuring 13.5 cm was resected and end to end anastomosis was done. Ladd’s procedure was done for malrotation. Histopathology showed the cyst attached to serosal aspect on the anti-mesenteric side without communication with ileum, but had a common muscular wall lined with simple columnar epithelium consistent with ileal duplication cyst. Baby was fed from the 7th day and was discharged uneventfully on the 14th postoperative day.