Newborn with anterior abdominal wall defect and dilated small bowel

Surgical image of gastroschisis — Surgical image shows an anterior abdominal wall defect with the small bowel protruding out of the abdomen, with no surrounding membranous sac. The small bowel loops are dilated. There was an atresia just distal to the cecum and the distal colon was small in caliber. A silo for the abdominal contents was constructed. A gastrostomy and cecostomy were also placed.

The diagnosis was gastroschisis and colonic atresia.

Newborn post op from repair of anterior abdominal wall defect

Surgical image of gastroschisis — Surgical image shows a silo over loops of bowel not encased by a membranous sac that is being sequentially reduced several days after the initial operation. The small intestine has been almost completely reduced into the abdomen.

The diagnosis was gastroschisis.

Teenager with crampy abdominal pain and vomiting

Surgical image of Crohn disease — Surgical image shows the terminal ileum, which is between the two forceps, to be thickened in nature, firm to palpation and to have mesenteric fat wrapped around it. The appendix is normal in appearance.

The diagnosis was Crohn disease.

A patriotic toddler with increasing stridor over time

Pathological image of an esophageal foreign body — Lateral radiograph of the airway (left) shows a radiopaque foreign body in the cervical esophagus which is associated with a large amount of retropharyngeal soft tissue swelling. Gross pathological image (right) shows a metal flag-shaped pin that was endoscopically retrieved from the patient’s esophagus.

The diagnosis was gastrointestinal foreign body which had been present for a long period of time.

Newborn with prenatal US showing polyhydramnios and a double bubble sign

Clinical image of duodenal atesia — Clinical image shows a massively distended abdomen.

The diagnosis was duodenal atresia.

Newborn with vomiting

Surgical image of duodenal stenosis — Surgical image shows a massively dilated second part of the duodenum in the center of the image. The decompressed proximal jejunum, being pinched between the thumb and forefinger, is seen to the left and inferior to the dilated duodenum.

The diagnosis was duodenal stenosis.

Preschooler with epigastric discomfort, especially when laying down to go to bed at night, who had a loop of bowel behind the sternum incidentally noted on a CXR

Surgical image of Morgagni hernia — Surgical image shows an anterior midline defect in the diaphragm, measuring 7 cm in width by 3 cm in depth. The transverse colon was herniated through this defect into the retrosternal space and had been reduced before this image was obtained.

The diagnosis was Morgagni hernia.

Newborn with respiratory distress

Gross pathological image of congenital diaphragmatic hernia — Gross pathological image shows portions of the intestine and spleen in the left hemithorax causing the heart to be displaced into the right hemithorax.

The diagnosis was left-sided congenital diaphragmatic hernia.

Preschooler who stools out of her vagina and rectum and is known to have a duplicated colon

Surgical image of colonic duplication — Surgical image shows the duplicated colon at the level of the sigmoid colon with the two colonic lumens running side by side. The mucosa was removed from the duplicated colon from the level of its sigmoid colon to the vaginal orifice. The duplicated colon was then anastomosed to the normal colon at the level of the normal colon’s sigmoid colon.

The diagnosis was colonic duplication.

Preschooler who stools out of her vagina and rectum and is known to have a duplicated colon

Clinical image of colonic duplication — Clinical image shows a normal anus and a probe in an extra orifice in the posterior vaginal wall which communicates with the second colonic lumen.

The diagnosis was colonic duplication.

Teenager with abdominal pain

Surgical image of acute appendicitis — Surgical image shows the appendix to be grossly inflamed with exudate, but not to be perforated.

The diagnosis was acute appendicitis.

Newborn female with an absent anus who stools out of her vagina

Clinical image of anorectal malformation — Clinical image shows normal appearing external genitalia, but no anus. Examination of the vaginal introitus reveals a rectal fistula to the posterior vaginal fourchette in the midline, located just inferior to the vagina.

The diagnosis was anorectal malformation with rectovaginal fistula to the vaginal fourchette.

Newborn with an absent anus

Clinical image of anorectal malformation — Clinical image shows meconium exiting the urethral meatus.

The diagnosis was anorectal malformation.

Newborn with bilious vomiting and a double bubble sign on AXR

Surgical image of duodenal atresia — In the operating room the duodenum was seen to taper between its second and third portions. A nasogastric tube could not be advanced past this area of tapering. There appeared to be a membrane obstructing the duodenum at this point. A duodenotomy was performed which confirmed the presence of a thick membrane completely obstructing the duodenum. Bile was seen above and below this membrane. The bile was coming from one papilla above the membrane and one papilla below it. Surgical image shows the superior retractor distracting the proximal duodenum and the inferior retractor distracting the distal duodenum. The obstructing membrane is seen between the retractors. The obstructing membrane was then incised.

The diagnosis was duodenal atresia.

Teenager with crampy abdominal pain and vomiting

Gross pathological image of Chron disease — Gross pathological image shows a normal cecum and appendix (right of image) and a stricture at the terminal ileum (middle of image), which is thickened. The terminal ileum is ulcerated with pseudopolyp formation at the stricture. Histopathology showed transmural inflammation of the terminal ileum with granuloma formation and ulceration.

The diagnosis was Crohn Disease.

Toddler with stridor since birth

Surgical image of right aortic arch with aberrant left subclavian artery — Surgical image taken through a left thoracotomy shows a blue vessel loop around the ligamentum arteriosum which was compressing the esophagus posterior to it. The red vessel loops are around the right aortic arch (on the right) and the left subclavian artery (on the left). The vascular ring was subsequently divided by division of the ligamentum arteriosum. The vascular ring then sprang open dramatically, relieving its compression upon the esophagus.

The diagnosis was right aortic arch with aberrant left subclavian artery and ligamentum arteriosum forming an incomplete vascular ring.

Newborn with abdominal distension after placement of a nasogastric tube

Surgical image of gastric perforation — Surgical image shows the surgical forceps in the center of the image delineating the size of the hole in the antrum of the stomach.

The diagnosis was gastric perforation.

Newborn with respiratory distress

Gross pathological image of asphyxiating thoracic dystrophy — Post-mortem gross pathological image shows an extremely small thorax due to shortened ribs, particularly when compared to the size of the abdomen.

The diagnosis was asphyxiating thoracic dystrophy.

Newborn who is lacking a cranial vault on physical exam

Pathological image of anencephaly — Post-mortem gross pathological image shows flattening of the top of the skull due to the absence of a cranial vault.

The diagnosis was anencephaly.

Infant with choking with feeding

Surgical image through a thoracotomy incision (left) shows blue vessel loop around an aberrant left subclavian artery arising from a Kommerell diverticulum. Black suture loop is around a patent ductus arteriosus that was noted to extend from the Kommerell diverticulum and completed a vascular ring which was compressing the esophagus posterior to it. Surgical image (right) with the patent ductus arteriosus mobilized off the esophagus which is between the tips of the hemostat show the esophagus now resorting to its normal caliber.

The diagnosis was right aortic arch with aberrant left subclavian artery and patent ductus arteriosus forming a complete vascular ring.

Infant with biphasic stridor that is most pronounced over the upper trachea

Surgical image of double aortic arch — Surgical image through a left posterolateral thoracotomy shows the red vessel loops around the double aortic arch and the blue vessel loops around the ligamentum arteriosum. The posterior aortic arch was divided, causing an impressive release of the ring with the 2 ends of the posterior arch separating by 2 to 3 centimeters. The ligamentum arteriosum was then divided.

The diagnosis was double aortic arch.

Newborn with an anterior chest wall defect including a split anterior half of the sternum, an omphalocele and a thoracoabdominal ectopic cordis

Surgical image of Pentalogy of Cantrell — Surgical image after the omphalocele sac was excised shows the apex of the heart (superiorly) and the liver (inferiorly). The pericardium was intact. The diaphragm was intact. The omphalocele was closed by approximating the abdominal fascia. The heart was covered with skin.

The diagnosis was Pentalogy of Cantrell.

Teenager with a chest wall deformity

Clinical image of pectus excavatum — Clinical image shows a marked concavity of the chest wall.

The diagnosis was pectus excavatum.

Newborn with congestive heart failure

Gross pathological image of infradiaphragmatic total anomalous pulmonary venous return — Gross pathological image shows the pulmonary veins joining into a common vein which descends through the diaphragm and which drains into the main portal vein within the liver.

The diagnosis was infradiaphragmatic total anomalous pulmonary venous return.

Newborn with abnormal kidneys and oligohydramnios on prenatal ultrasound

Clinical image of Potter syndrome due to pulmonary hypoplasia — Clinical image shows Potter’s syndrome – a flattened nose, recessed chin, prominent epicanthial folds and low set of abnormal ears.

The diagnosis was Potter syndrome due to pulmonary hypoplasia.