0:00

So this is a brand new baby who

0:04

is a full term baby and he has

0:09

biliary, vomit, bilis, vomiting,

0:12

and we were asked to look for mal rotation

0:17

and uh, ulus. So let me show you the plain film.

0:21

Plain film did not demonstrate any, um,

0:26

any kind of acute abnormality.

0:27

Some air distension of the bowel loops in the upper diamond,

0:32

but with the um, newborn you can sometimes see the gases distention.

0:39

We put the contrast, we put the contrast to the nasogastric tube.

0:44

This is the contrast to ation of the stomach.

0:48

And there is a loop which does not look like durum.

0:52

We would like to see gastric outlet or pacifying the sea loop.

0:57

And then the sea loop should terminate in the ligament of trites,

1:01

which should be located in, in the left paraspinal region.

1:05

So after multiple attempts of for pushing the contrast

1:10

and the stomach, it used to reflux back and there was very little transit.

1:16

Uh, and let me show you an image.

1:18

This was obtained after 20 minutes of installing the contrast in the stomach.

1:25

This was 60 minutes later.

1:29

It did travels and through the probably some kind of loop,

1:32

which we don't know what kind of loop is that. And then it started to, uh,

1:38

come back to the right side. On the lateral,

1:42

you can see the stomach is decompress.

1:43

This is almost 70 minutes after instilling the contrast in the stomach.

1:48

And there is this non-specific, we don't know, this is a featureless loop, um,

1:52

which calls upon itself, but then it does not have, uh,

1:57

that appearance, which, which could potentially worry us, uh,

2:01

that it is something acute. Um,

2:04

there are multiple dilated loops in the bowel. However,

2:06

there is no fixed bowel gas pattern or there is no pattern to

2:11

the de genome or ileum.

2:14

And let me show you a last one.

2:18

This is almost like three hours.

2:21

So all the pediatric radiologists who have experience of doing upper GI for mal

2:25

rotation, if there is mal rotation, ous, you see certain abrupt uh,

2:30

obstruction at the mid gut level. And um,

2:35

if there is no obstruction, there is no mid guard ular.

2:40

The contrast passes through the gastric outlet and opacifies the sea loop within

2:44

five to 10 minutes if there is no dismotility.

2:47

So here we are dealing with a case where we have somewhat normal appearing

2:52

stomach and there are so many loops which are featureless,

2:58

and the movement of the contrast is extremely slow.

3:02

It took almost four hours to get to this last image.

3:07

Um, I have a feeling this is potentially colon,

3:10

but I am not a hundred percent sure. So after 24 hours,

3:14

we obtained another image which showed residual contrast in the bowel loops.

3:20

So we have to think about the differential here. Uh,

3:24

we call the surgeons and let them know that this is not acute, uh,

3:28

but there is a problem. So let us show the questions please. Cool,

3:33

short. So because it is not acute and we kept on imaging them for four hours,

3:38

24 hours is definitely not acute. So it cannot be ous.

3:43

Um, this was short syndrome or short actually not syndrome.

3:48

Short syndrome is usually associated with gastroschisis, um,

3:52

when the patient loses bunch of bowel. And, um,

3:57

the rest of the bowel loops are, uh, very, um,

4:01

distal and dilated and they are very dysfunctional.

4:05

So congenital, uh, shortcut is extremely rare.

4:09

This is a TW 2008 article,

4:11

which share said that less than 40 reported cases are there in the literature.

4:16

Uh,

4:16

congenital short is associated with less than 75 centimeters of the length of

4:20

the total bowel. So starting from the stomach to the anus, there's only,

4:26

um, less than 75 centimeters of the total bowel. Um,

4:31

the theory is either there is ischemia or there is some

4:35

dysfunction or delayed or interrupted function of normal elongation rotation

4:40

and herniation of the small in intestine. So if we visit back to embryology,

4:45

the intestine is formed as a small short tube. It elongates, it rotates,

4:51

it rec canalizes,

4:52

it herniates outside the body comes back into inside the belly,

4:56

and then the mesentry is formed and the ligament of tri is fixed.

5:01

So if any of this is interrupted during the, um, fetal life,

5:06

then you can get congenital shortcut. Uh,

5:10

the problem is these, these bowel loops which are formed,

5:14

they're all abnormal. They are dilated, they're distal. Um,

5:19

they always have associated malrotation because there is no enough ENT

5:24

formation. So there is always malrotation vous is,

5:29

it can be seen in these patients, but you can,

5:31

you should see abrupt termination of the contrast of, uh,

5:35

and there is no specification past that obstruction. So in our patient,

5:40

there was no ous. Uh, in patients who have congenital short,

5:45

uh, the mean survival years is only six years. This is,

5:50

uh, because there is usually bacterial overgrowth, um,

5:54

infection, perforation, peritonitis,

5:57

And the patients die out of that. Also, the, uh,

5:59

the patients usually present with failure to thrive. If, uh,

6:03

congenital shortcut is not diagnosed early on, like in extreme brand new baby,

6:08

then the patients present with failure to thrive.

6:11

So this was congenital shortcut with abnormal, uh,

6:16

configuration and, uh, disor loops, which did not move much. Uh,

6:20

there were very little bubble loops also. They were not moving much.