International Journal of Contemporary Pediatrics

Rattan KN et al. Int J Contemp Pediatr. 2017 Mar;4(2):xxx-xxx

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Case Report

Acquired colonic atresia in a 4-month old term male infant:

a rare case report
Kamal Nain Rattan1, Gurupriya J.1*, Shruti Bansal1, Rohit Kapoor2, Roomi Yadav1

1
Department of Department of Pathology, 2Department of Pediatrics, Pandit Bhagawat Dayal Sharma, Post Graduate
Institute of Medical Sciences, Rohtak, Haryana, India

Received: 01 January 2017

Accepted: 30 January 2017

*Correspondence:
Dr. Gurupriya J.,
E-mail: guru26890@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Acquired colonic atresias are very rare but, are known in association with necrotizing enterocolitis. We report a case
of a 4-month term male infant with recurrent episodes of abdominal distension, bilious vomiting and constipation off
and on, without the history of necrotizing enterocolitis. Exploratory laparotomy was performed, an inflammatory
mass with multiple dense interloop adhesions were found in the mid-transverse colon. These adhesions were lysed to
identify the proximal dilated and distal blind end of the colon. Rest of the gut was normal. This case is unique for the
fact that, it is a case of acquired colonic atresia without history of necrotizing enterocolitis, unlike other reported cases
of acquired colonic atresia.

Keywords: Acquired intestinal atresia, Intestinal obstruction, Necrotizing enterocolitis

INTRODUCTION birth. The child passed meconium within the first 6 hours
of birth and was normal until 3 months after birth.
Intestinal atresia is a condition in which there is complete
obliteration of the bowel lumen. Majority of intestinal At 3 months of age the child presented with abdominal
atresias are congenital. Congenital intestinal atresias are distension, vomiting and constipation. A diagnosis of
rare in the colon.1 Acquired atresias of the intestine are subacute intestinal obstruction was made and he was
extremely rare. Acquired colonic atresias have been treated conservatively with IV fluids, antibiotics and
reported as a consequence of necrotizing enterocolitis.2,3 suppositories. Presently, he had the same symptoms and
We report a very unusual case of acquired colonic atresia on examination the child was severely dehydrated,
without the association of necrotizing enterocolitis. abdomen was soft and distended and revealed visible
peristalsis. All the laboratory investigations were done,
CASE REPORT renal function test including electrolytes were within
normal limits. An erect abdominal plain radiograph
A 4-month-old male child presented with history of revealed multiple air fluid levels (Figure 1).
recurrent abdominal distension, bilious vomiting and
constipation off and on for a period of 1 month. The child A barium enema contrast study performed soon after
was born to a 26- year old primigravida at 38 weeks revealed blind end of the colon, the dye was not seen
gestation by spontaneous vaginal delivery with a birth beyond transverse colon (Figure 2).
weight of 2.5 kgs. There was no significant antenatal
history. He had a history of delayed crying and fever after A provisional diagnosis of Hirschsprung disease was
made.

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Exploratory laparotomy revealed an area of obstruction in

the mid transverse colon. The obstruction was due to an
inflammatory mass with multiple dense interloop
adhesions. These adhesions were lysed, the portion of
colon proximal to the mass was dilated and the distal
portion revealed a micro colon, both the portions ending
blindly. Remainder of the gut was normal. An end
colostomy was performed. A biopsy performed from the
portion of colon distal to the mass and was sent for
histopathologic examination, showed the presence of
ganglion cells. His post-operative period was uneventful
and was discharged after 7 days. After a period of two
months the patient was admitted again, re-explored and
an end to end colo-colic anastomosis was performed.
Post-operative course was uneventful and the child
recovered well.

DISCUSSION

Congenital atresias of the gut are caused by vascular

compromise during early stages of pregnancy.4 Although
majority of them are caused by a vascular event, new
evidence suggests the presence of a genetic mechanism in
the pathogenesis.5 The aetiology of congenital atresias of
the duodenum is due to failure of recanalization and its
co-existence with trisomy 21 is well documented.6
Acquired atresias of the intestine are documented rarely
in premature infants after recovery from necrotizing
enterocolitis. Necrotizing enterocolitis (NEC) is a severe
Figure 1: Plain erect abdominal radiograph of the inflammatory disorder of the bowel common in pre-term
patient showing multiple air-fluid levels. infants. Classic signs and symptoms of necrotizing
enterocolitis (NEC) include bilious vomiting, abdominal
distention, and bloodstained stools. The acquired atresia
of intestine in cases with NEC, the affected segment was
observed to be distal to an established enterostomy.7,8
Acquired colonic atresias are an extremely rare entity.
We could only find four cases of acquired colonic atresia
all associated with necrotizing enterocolitis.

Beardmore HM et al reported two cases of acquired

colonic atresia subsequent to necrotizing enterocolitis,
both of the patients were premature male infants one of
them presented at 5 days after birth and another at 24
hours after birth with bloody stools, vomiting and
abdominal distention.2 Mares AJ et al reported two cases
of acquired colonic atresia as a sequele of necrotizing
enterocolitis, both the patients were premature female
infants presenting at 2 days of birth and 18 days of birth
with classical features of necrotizing enterocolitis.3
Intestinal atresias which were not associated with
necrotizing enterocolitis were very rare with only seven
reported cases in English literature and all in the small
intestine. The reason for atresia described by one of these
authors was a thromboembolic event interrupting blood
supply to a particular segment of intestine resulting in
stenosis or atresia of that segment.9 In five cases the
Figure 2: Barium enema contrast study of the patient reason was due to the presence of adhesive bands
showing micro-colon and absence of the dye beyond interrupting blood supply causing ileal atresiaand in one
the transverse colon. case the reason was due to ileo-colic intussusception.10-13

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 Rattan KN et al. Int J Contemp Pediatr. 2017 Mar;4(2):xxx-xxx

It is important to note that in our case the infant was born growth factor 10 signalling pathway. J Pediatr Surg.
at term and there were no symptoms and signs of 2005;40(2):390-6.
necrotizing enterocolitis. We failed to find in English 6. Akinloye OW, Truong W, Giacomantonio M,
literature a case of acquired colonic atresia without the Mateos D, El-Naggar W. Co-existence of meconium
association of necrotizing enterocolitis. The underlying ileus with duodenal atresia and trisomy 21 in a
pathophysiology is presumed to be either a recurrent newborn: a case report. J Perinatol. 2014;34:875-6.
colo-colic intususseption or recurrent local infection 7. Jona JZ. Acquired ileal atresia and spontaneous
leading to the inflammatory process or perforation at the reconstitution of intestinal continuity in a premature
local site leading to the formation of thrombus followed infant with necrotizing enterocolitis. J Pediatr Surg.
by mesenteric vascular occlusion. 2000;35:505-7.
8. Choi SO, Park WH, Kang JS. High jejunal
Funding: No funding sources obstruction as a sequelae of necrotizing
Conflict of interest: None declared enterocolitis. J Korean Med Sci. 1991;6(2):183-6.
Ethical approval: Not required 9. Ratan SK, Rattan KN, Mathur SK, Maheshwari J,
Seghal T. Acquired ileal atresia in infancy: a report
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