A neonate presents on day 2 with bilious vomiting and a 'double bubble' sign on abdominal X-ray. Laparotomy confirms duodenal atresia with a 'type III' complete atresia. Which associated anomaly must be ACTIVELY excluded before and during surgery due to its high co-occurrence?

• A Down syndrome (trisomy 21) associated anomalies and cardiac defects ✓
• B Tracheo-oesophageal fistula
• C Malrotation requiring Ladd's procedure at the same time
• D Anorectal malformation

Explanation

Duodenal atresia has a strong association with Down syndrome (trisomy 21) in approximately 30% of cases. Before surgery, karyotyping or rapid FISH should be performed and echocardiography is mandatory given the high prevalence of congenital heart disease in trisomy 21 (endocardial cushion defects, VSD, ASD), which significantly influences anaesthetic risk and post-operative management. Intraoperatively, annular pancreas is found in ~20% of duodenal obstruction and is not divided; instead, a duodenoduodenostomy bypasses it. Malrotation can co-exist but is not the primary exclusion priority during pre-operative assessment.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.