“Reversed Wind Sock Sign” of Congenital Membranous Atresia of the Colon

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  • Kawano Shinya
    Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine
  • Chiba Masahiro
    Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine
  • Nakagami Tomokazu
    Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine
  • Suzuki Komei
    Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine
  • Watarai Yu
    Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine
  • Toki Akira
    Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine

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Other Title
  • 逆吹き流し像（reversed wind sock sign）を呈した先天性結腸膜様閉鎖症の1例
  • 症例報告 逆吹き流し像(reversed wind sock sign)を呈した先天性結腸膜様閉鎖症の1例
  • ショウレイ ホウコク ギャクフキ ナガシ ゾウ(reversed wind sock sign)オ テイシタ センテンセイ ケッチョウマク ヨウ ヘイサショウ ノ 1レイ

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Abstract

A 2-day-old girl, who was born at full term with a weight of 3,260 g, presented with abdominal distension and continuous vomiting. An abdominal roentgenogram showed multiple distensions of the small intestinal loop and a soap-bubble appearance in the lower abdomen. The followingcontrast enema using gastrografin revealed a distal microcolonand a colonic obstruction near the cecum. In the region of the obstruction, the contrast collected in the pouch formed by the membrane, which distended into the dilated cecum. When the contrast was deflated, the wind-sock-like membrane was reversed in the opposite direction by the pressure of the cecal contents. A diagnosis of membranous atresia of the ascending colon was made, and the patientunderwent surgery. To avoid an ileocecal resection, a resection of the membrane and a tube cecostomy were performed with an indwelt transanastomotic tube. After the operation, so as not to have a stagnant loop, the patient was fed orally with careful observation, and the cecum was deflated through the cecostomy for 2 months. The cecostomy functioned subsequently as a safety valve and was closed 11 months after the initial operation. The patient is doing well at age 4 with normal ileocecal valve function and within a normal growth range. Although membranous atresia of the colon is a rare cause of intestinal obstruction in neonates, the “reversed wind sock sign” that we described for the first time in the literature is notable in making a definitive preoperative diagnosis of such atresia.

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