Anomalous pancreatic ductal system allowing distal bowel gas with duodenal atresia

A twelve-day-old male presented with non-bilious, non-bloody emesis 2 hours after feeding since two-days-old, with flatus and light stools since birth. An upper gastrointestinal series (UGI) at an outside institution was reported as normal. Abdominal radiographs demonstrated distal bowel gas with proximal duodenal dilation. Abdominal ultrasound demonstrated gas in the main pancreatic duct and a dilated, fluid-filled duodenum. An UGI revealed duodenal atresia with enteric bypass by congenital anomaly of the pancreaticobiliary system. At thirteen days old the patient underwent uncomplicated duodenoduodenostomy. The post-operative course was uneventful and the patient subsequently tolerated oral feeds. Bypass of the atretic duodenal segment through an anomalous pancreatic ductal system is a rare anomaly described in the literature in only a handful of cases. This case report highlights the importance of considering duodenal atresia and pancreaticobiliary enteric bypass in the differential diagnosis of neonates presenting with partial duodenal obstruction. On ultrasound, the presence of gas in the biliary tree or pancreatic duct should alert the physician to the possibility of duodenal atresia with congenital pancreaticobiliary duct anomalies that allow for bypass of enteric contents, including air, into more distal bowel, thereby creating a gas pattern aptly described as double bubble with distal gas

Fibromatosis of the cervical region following laminectomy: a case report and literature review

STUDY DESIGN: A case report and a discussion of recently published data. OBJECTIVE: To highlight the occurrence of postoperative fibromatosis arising in the cervical spine. SUMMARY OF BACKGROUND DATA: Fibromatosis is a benign, locally invasive fibroblastic proliferation that can cause compressive effects on adjacent structures. Although the precise etiology of fibromatosis remains unclear, numerous studies have investigated the role of pluripotent mesenchymal stem cells in β-catenin-regulated tumorigenesis. At present, aggressive fibromatosis is managed with wide local excision. Postoperative radiation therapy is indicated for incomplete excision. METHODS: A 48-year-old woman presented with a 2-year history of enlarging paracervical fibromatosis after undergoing extensive cervicothoracic instrumentation for excision of an extradural schwannoma. The patient underwent wide local excision of the neck mass, with right trapezius myocutaneous flap reconstruction of the subsequent defect. RESULTS: Histologically, the lesion was shown to be fibromatosis. Six months postoperatively, the patient was doing well with no recurrence. CONCLUSION: Fibromatosis is an important diagnosis to consider when evaluating locally aggressive spinal lesions at sites of prior operative repair. Molecular and genetic studies pertaining to the role of mesenchymal stem cells and β-catenin in the pathogenesis of aggressive fibromatosis tumors could lead to possible worthwhile treatment strategies in the future