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Duodenal atresia is a condition typically diagnosed in the neonatal period. Here, we discuss an 11-year-old patient with a new diagnosis of duodenal atresia, discovered during a lysis of adhesions. The patient had a history of malrotation and was status-post Ladd’s procedure, but had continued to experience bilious emesis and symptoms of intestinal obstruction since 1 month of age, resulting in lifetime TPN dependence. She was subsequently diagnosed with microcolon megacystic hypoperistalsis syndrome (MMHS) and underwent loop jejunostomy creation that proved unsuccessful in relieving her symptoms. Duodenal atresia was recognized and repaired intraoperatively during a planned loop jejunostomy revision.