Giant congenital diverticula and neonatal rupture of colon: A case associated with true congenital partial hypertrophy of the crossed type.

Clinical history. The patient died on the twelfth day of life, having been delivered by a Caesarian operation for disproportion. He was difficult to resuscitate at birth and the abdomen always appeared distended. This distension varied somewhat, but there were no other unusual symptoms until he suddenly collapsed and died in two hours. Post-mortem examination. The body was that of a well-nourished male infant. The left side of the cranium and face, especially the mandible and ear, was larger than the right. This asymmetry was less marked posteriorly. No certain difference could be detected in the arms, thorax or abdomen, but the left leg was 2 cm. shorter than the right and this was largely accounted for by the shortening of the femur. The thickness of the thigh was proportionately altered, but asymmetry of the feet was not detected. On opening the cranium the left anterior and middle fossae of the skull were obviously larger than the right, but the disporportion between the posterior fossae was less certain. The cerebral convolutions were normal, but the cerebrum and even the cerebellum and pons shared in the asymmetry of the skull. No asymmetry of the thoracic or abdominal organs was demonstrable. Except for the pelvic colon the contents of the thorax and abdomen were normal. The colon had a long free mesentery and lying in it, and slightly behind the bowel and almost 7 cm. from the anus, there was a cystic cavity 4 cm. from side to side, 3 5 cm. from above downwards and 2 cm. from front to back (fig. 1). This communicated with the lumen of the bowel by an orifice 1-2 cm. by 0 5 cm. in diameter. Its walls were 2 to 3 mm. thick, but showed no condensation of muscle into bands. Beginning 4-5 cm. above this opening and extending for 3 0 cm. the mesenteric wall of the bowel was expanded into a similar cavity with thick walls. Both diverticula received their blood supply from the arcade of the inferior mesenteric artery. The superior cavity extended 1-0 cm. above and 1 5 cm. below its wide entrance, and when it was dilated the part below the opening was capable of compressing the adjacent bowel and producing obstruction. Immediately opposite this upper aneurysmal like