He was transferred to our facility for evaluation of multiple congenital anomalies (Figure 1).

Neural tube defect, split vertebral column, imperforate anus, double descending thoracic aorta, and absent spleen in a term infant.

The actual diagnosis was split notochord syndrome. Meningocele was repaired and physical therapy ordered. Due to absent sacrum and coccyx, parents were informed about the prognosis of their child not being able to ambulate. Colostomy was performed for an imperforate anus. Intestinal duplication cyst was excised. Absent spleen noted during the surgery and decision was made to observe. No invasive cardiac procedures were necessary. Bilateral scrotal hernia was repaired. Post operatively, he faced extubation difficulty, remained on oxygen for weeks, and eventually needed tracheostomy. He developed feeding difficulties after colostomy and needed a g tube. Chromosome analysis revealed 46 XY. Posterior phallic structure is still being evaluated. He was discharged home with tracheostomy, g tube,...

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