CASE HISTORY

The baby was admitted as an acute intestinal obstruction, having passed nothing per rectum since birth. The nurse stated that an olive oil enema was returned unchanged. The infant vomited all it was given. On examination: the abdomen was distended. no mass resembling intussusception was felt, and no obstruction was felt per rectum. Congenital anomaly of recto-sigmoid junction or else megacolon was suspected. About 11 hours after admission the baby vomited faecal matter and became more distended. Operation was performed under local anaesthesia and many coils of greatly distended small intestine were seen. One long loop of contracted deep blue small intestine was seen, covered in lymph. It appeared to have a constriction in its wall. At this point the child’s condition became very poor and the operation was terminated. She died 1.5 hours after operation and came to autopsy with a diagnosis of acute obstruction of intestine with congenital atresia.

PATHOLOGY

The specimen consists of several loops of ileum, the more proximal parts of which are very greatly distended while the rest is contracted. The distension of the upper intestine stops abruptly at one point, seen in the upper right portion of the specimen, and here the bowel is ballooned out blindly. At autopsy it was found to continue as a solid cord from the inner aspect of this distended end for about 1 " and distal to that the remainder of the ileum is contracted, but was patent. No histology was obtained from this specimen.