Dextrocardia with situs inversus co-existing with neonatal intestinal obstruction

Abstract

Background: Dextrocardia and situs inversus are still rare congenital abnormalities that are asymptomatic and compatible normal life. They are characterized by mirror image transposition of all intra-thoracic and intra-abdominal viscera. There may be other co-existing congenital defect(s) producing symptoms and necessitating treatment.
Aim: To report the first case of dextrocardia with situs inversus diagnosed in this hospital, and the management of intermediate-type ano-rectal malformation (ARM) which co-existed in the patient.
Case Report: A three-day-old male neonate who was born at home, presented with inability to pass meconium, associated with abdominal distension and vomiting. Physical examination revealed cardiac apex on the 4th right intercostal space, along the mid-clavicular line, abdominal distension with hyper-active bowel sound, and blind-ended anus at about 1.5-2.0 cm from the anal verge. Chest and abdominal radiogram, and exploratory laparotomy confirmed the diagnosis of dextrocardia with situs inversus. Lateral invertogram showed cut-off of rectal gas shadow at the level of the tip of coccyx, consistent with intermediate-type ARM, which was successfully treated by abdomino-perineal ano-rectoplasty. The patient has remained well 10 months after discharge.
Conclusion: Routine physical examination of all newborn babies in the delivery suite is recommended for early diagnosis of dextrocardia and situs inversus to avert the problems of wrong diagnosis when acute surgical abdomen occurs in such individuals.


Keywords: Dextrocardia, Situs inversus, Ano-rectal malformation

PHMJ Vol. 2 (2) 2008: pp. 177-180