Giant Meckel’s diverticulum associated with oesophageal atresia, tracheo-oesophageal fistula and cleft lip and palate

Received: 28 April 2004 Revised: 3 August 2004 Accepted: 4 August 2004 Published online: 27 October 2004 Springer-Verlag 2004 A boy born at term to a 20-year-old healthy mother presented with oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF). Surgical correction was performed on the first day of life. The boy also had bilateral cleft lip and palate, surgically closed at the age of 11 weeks. Because of swallowing difficulties with recurrent aspiration complicated by pneumonia, temporary feeding via a jejunostomy tube became necessary. Multiple radiographs of the chest and abdomen showed a huge air-filled lesion in the right upper and mid abdomen (Fig. 1). Despite the absence of gastrointestinal symptoms, an upper GI series was performed at the age of 12 weeks. Contrast medium faintly opacified the air-filled viscus, which measured 11·10·5 cm (Fig. 2a). Because opacification occurred late, it was believed to be in connection with the colon. A contrast enema demonstrated the transverse colon displaced by the air-filled viscus (Fig. 2b). Cystic duplication of the terminal ileum was suspected. At surgery at the age of 15 weeks a giant Meckel’s diverticulum (MD) was found and resected. Neonates with OA, with or without TOF, have a high incidence of associated congenital anomalies, the cardiovascular system being most commonly affected. OA combined with cleft lip and palate is known but occurs seldom [1, 2]. Although MD represents the most common congenital anomaly of the gastrointestinal tract, giant MD is a rare entity, constituting <0.5% of all vitelline duct remnants [3]. To our knowledge this is the first case describing the association of a giant MD with OA and TOF, which might now be considered part of the wide spectrum of associated anomalies in children with the tracheo-oesophageal malformation complex. Pediatr Radiol (2005) 35: 216–217 DOI 10.1007/s00247-004-1327-0 CLINICAL IMAGE