case_images: PMC11420036_01
case_images: The upper gastrointestinal contrast study conducted on the third day of life confirmed the intrathoracic positioning of the stomach (asterisk) within the right hemithorax. Additionally, segments of the jejunum, ileum, proximal colon, and appendix (arrow) were also found to be located intrathoracically.
case_images: fped-12-1378234-g001.jpg
case_images: PMC11420036_01_fped-12-1378234-g001.jpg
case_images: F1
case_images: Therefore, after stabilization of the patient an upper gastrointestinal contrast study (upper GI study) was performed at her 3rd day of life (see Figure 1) to rule out gastrointestinal atresia.
case_images: (a) Intraoperative findings on the 4th day of life: A substantial portion of the bowel protruded into the thorax through the central diaphragmatic defect. The stomach appeared small and was attached to a brachyoesophagus, while the pancreas was situated intrathoracically. No spleen was identifiable. (b) During the initial surgery, efforts were made to relocate the bowel into the abdomen; however, due to a short esophagus, only small portions of the stomach could be repositioned, resulting in fixation at the diaphragm. (c) Current status at 13 months of age: Notable features include a tracheostomy, collar esophageal fistula, closed diaphragmatic defect, gastrostomy, gastrojejunostomy, duodenojejunostomy, and jejunostomy, the latter performed as a Roux-Y-anastomosis.
case_images: fped-12-1378234-g002.jpg
case_images: PMC11420036_01_fped-12-1378234-g002.jpg
case_images: F2
case_images: Intraoperative discoveries were mostly those seen in US and upper GI study except for that the stomach was not only small but also attached to a very short esophagus (see Figure 2).
case_images: The MRI image illustrates compression of the spinal cord by the atlas (arrow) and axis (asterisk), resulting in a significant narrowing of the spinal canal to 5 mm.
case_images: fped-12-1378234-g003.jpg
case_images: PMC11420036_01_fped-12-1378234-g003.jpg
case_images: F3
case_images: A pronounced rachischisis of the cervical spine was found, in addition to a compression of the spinal cord by the atlas and axis with an absolute narrowing of the spinal canal to 5 mm (see Figure 3).