{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:08:42Z","timestamp":1762848522260,"version":"build-2065373602"},"reference-count":14,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,21]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>Aperta lipomyelomeningocele (LMMC) is a form of open spinal dysraphism often associated with Chiari II malformation. Infantile hypertrophic pyloric stenosis (IHPS), the leading surgical cause of gastric-outlet obstruction in early infancy, has rarely been reported alongside LMMC and Chiari II. We present a term male neonate who underwent early repair of lumbosacral LMMC and later ventriculo-peritoneal (VP) shunting for post-haemorrhagic hydrocephalus. Persistent non-bilious vomiting despite functional shunting led to imaging that confirmed IHPS. The infant required a phased surgical approach, combining Ramstedt pyloromyotomy with simultaneous VP shunt revision, followed by extended multidisciplinary rehabilitation. The coexistence of these three distinct congenital anomalies produced overlapping symptoms and delayed IHPS diagnosis. This case emphasises the need for vigilant reassessment of ongoing gastrointestinal symptoms in children with neural tube defects and explores embryological links between these conditions. Recognising such rare associations is vital for timely intervention and improved outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-268860","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:05:34Z","timestamp":1762848334000},"page":"e268860","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Double jeopardy in early infancy: aperta lipomyelomeningocele with Chiari II malformation complicated by infantile hypertrophic pyloric stenosis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9529-4422","authenticated-orcid":false,"given":"Deepthi","family":"Kattamanchi","sequence":"first","affiliation":[{"name":"Neonatology, SIMATS Deemed University Saveetha Medical College and Hospital, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumutha","family":"Jayaraman","sequence":"additional","affiliation":[{"name":"Neonatology, SIMATS Deemed University Saveetha Medical College and Hospital, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santhosh Kumar","family":"Kamalakannan","sequence":"additional","affiliation":[{"name":"Neonatology, SIMATS Deemed University Saveetha Medical College and Hospital, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha","family":"Arun","sequence":"additional","affiliation":[{"name":"Neonatology, SIMATS Deemed University Saveetha Medical College and Hospital, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"2025111100052530000_18.11.e268860.1","article-title":"Chiari II malformation: pathophysiology and management","volume":"10","author":"McCormick","year":"2001","journal-title":"Neurosurg Focus"},{"key":"2025111100052530000_18.11.e268860.2","doi-asserted-by":"crossref","first-page":"100502","DOI":"10.1016\/j.inat.2019.100502","article-title":"Myelomeningocele - A literature review","volume":"19","author":"Ntimbani","year":"2020","journal-title":"Interdiscip Neurosurg"},{"key":"2025111100052530000_18.11.e268860.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7479.1375"},{"key":"2025111100052530000_18.11.e268860.4","first-page":"1201","article-title":"Evolving insights into the aetiology of infantile hypertrophic pyloric stenosis","volume":"38","author":"Panteli","year":"2022","journal-title":"Pediatr Surg Int"},{"key":"2025111100052530000_18.11.e268860.5","first-page":"561","article-title":"Concurrent abdominal surgery at the time of VP- shunt placement does not increase shunt infection","volume":"19","author":"McAteer","year":"2017","journal-title":"J Neurosurg Pediatr"},{"key":"2025111100052530000_18.11.e268860.6","first-page":"1150","article-title":"Peri-operative airway management in Chiari II malformation: lessons from 102 procedures","volume":"26","author":"Reddy","year":"2016","journal-title":"Paediatr Anaesth"},{"key":"2025111100052530000_18.11.e268860.7","first-page":"1","article-title":"Developmental genetics of gastrointestinal obstruction","volume":"103","author":"Burke","year":"2023","journal-title":"Clin Genet"},{"key":"2025111100052530000_18.11.e268860.8","first-page":"1","article-title":"Embryology of congenital malformations of the spine and spinal cord","volume":"12","author":"Dias","year":"2001","journal-title":"Neurosurg Clin N Am"},{"key":"2025111100052530000_18.11.e268860.9","first-page":"59","article-title":"Neuropsychological outcomes in spina bifida myelomeningocele","volume":"16","author":"Fletcher","year":"2010","journal-title":"Dev Disabil Res Rev"},{"key":"2025111100052530000_18.11.e268860.10","first-page":"1931","article-title":"Coexistent spina bifida aperta and IHPS \u2013 diagnostic dilemma","volume":"28","author":"George","year":"2012","journal-title":"Childs Nerv Syst"},{"key":"2025111100052530000_18.11.e268860.11","first-page":"1357","article-title":"Association of myelomeningocele and pyloric stenosis: a case report","volume":"30","author":"Salgado","year":"1995","journal-title":"J Pediatr Surg"},{"key":"2025111100052530000_18.11.e268860.12","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.12027"},{"key":"2025111100052530000_18.11.e268860.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"2025111100052530000_18.11.e268860.14","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0764"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-268860","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:05:36Z","timestamp":1762848336000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-268860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":14,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,10]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bcr-2025-268860"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-268860","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}