A case report of VACTERL syndrome (anorectal, cardiac and renal malformations)

Introduction. VACTERL is a rare condition, named after the spectrum of malformations characterizing it: vertebral/vas­cu­lar anomalies, anal atresia, cardiac malformations, tracheo-esophageal fistula, renal anomalies, limb ano­ma­lies. Case presentation. We report the case of a male infant who presented in our clinic with the suspicion of inborn error of metabolism due to the severe metabolic acidosis and hypoglycemia. He was operated in the second day of life for imperforate anus and rectoperineal fistula. The radiological examination revealed severe bronchopneumonia for which he required antibiotic treatment and electrolyte infusions for the correction of the acidosis. Starting from the anorectal anomalies, we performed imagistic investigations that detected atrial septal defect and unilateral kidney agenesis. Based on the presence of three specific anomalies, we could establish the diagnosis of VACTERL association and we started the supportive treatment. Conclusions. VACTERL association is a complex spectrum of malformations, some of them with high mortality if they are not corrected on the right moment.