Transverse colonic atresia with rectal atresia in a neonate – A rare case of double-site intestinal atresia

Abstract

BACKGROUND: Colonic atresia is among uncommon and extremely rare congenital anomalies, accounting for less than 15 % of all intestinal atresias, with an estimated incidence of 1 in 20,000 live births. Even rarer is the coexistence of colonic atresia with rectal atresia, which has been reported in only a few cases globally. These dual conditions lead to neonatal intestinal obstruction, requiring early diagnosis and surgical intervention to prevent life-threatening complications. CASE PRESENTATION: Herein a 2-day-old neonate presented with a grossly distended, tense abdomen and bilious vomiting. Digital rectal examination (DRE) revealed that the examiner's finger could not pass beyond 2 cm from the anal verge. Saline irrigation and enema catheter insertion failed, leading to a preoperative diagnosis of rectal atresia. Intraoperative findings revealed a dilated small intestine and grossly dilated colon up to the level of the distal transverse colon, with the ascending and sigmoid colon replaced by fibrous-like tissue. The affected segments were excised, necessitating a future coloanal anastomosis. A double-barrel ileostomy was performed, and a biopsy was taken from the dilated transverse colon. DISCUSSION: The rarity of combined distal transverse colonic atresia and rectal atresia presents significant diagnostic and surgical challenges. The condition likely results from intrauterine vascular disruptions. Early surgical intervention offers favorable outcomes, though long-term bowel function remains a concern. CONCLUSION: This case highlights the importance of early diagnosis and tailored surgical management in complex intestinal atresias to improve survival and long-term outcomes.