Apple Peel Small Bowel, A Review of Four Cases: Surgical and Radiographic Aspects

Abstract

Background: Although apple peel intestinal atresia is rare and is associated with a high mortality and morbidity, there is a dearth of its report in African literature. This study reviews four of the cases seen in a state teaching hospital in Lagos, considering the radiographic findings, surgical management and outcome. A brief review of literature is also undertaken. Aims and Objectives: To correle the plain radiographic findings with the surgical findings of neonates gathered over a six year period and to evaluate their surgical management, hoping to further help improve management of such neonates' in future in resource limited regions such as ours. Methodology: It was a retrospective case series of four neonates who were brought in over a period of six years and operated after an initial plain abdominal X-ray. They were done as emergency cases, consent was obtained from their parents and the study was approved by the research and ethics committee. Operative findings were subsequently correlated with their radiographic findings and the surgical outcomes and follow up were documented. Conclusion: This study revealed that "the triple bubble sign" is a common radiographic finding in Apple Peel deformities, as well as gangrene of the jejunum and ileum at surgery.

Jejunal atresia in the newborn: three cases after resection and end-to-end anastomoses

“…The role of diagnostic imaging is to help determine as accurately as possible the exact nature of the abnormality. 5,6 Besides, the appropriate surgical procedure is necessarily important to improve the outcome and minimalize the complications. Based on those mentioned above, this case reports aim to evaluate the outcome of resection and end-to-end anastomoses surgical technique to the newborn with jejunal atresia.…”

A jejunal atresia type I in newborn: a case report

“…2,4 Intestinal atresias are frequently associated with polyhydramnios. 5,6 Therefore, many of these patients are born prematurely and often are small for their gestational age, the latter due to the inability to absorb nutrients from the amniotic fluid in patients with proximal intestinal obstructions. Intestinal atresia should be suspected in any newborn showing evidence of bowel obstruction (bilious vomiting, abdominal distention, and failure to pass meconium).…”

“…In most patients, a simple abdominal x-ray with anteroposterior (AP) and either cross-table or left lateral decubitus projection are adequate to make the diagnosis based upon the presence of dilated, air-filled intestinal loops and air-fluid levels. 5,6 All patients should receive proper fluid hydration prior to operative intervention. Besides, a nasogastric or orogastric tube should be passed to empty the stomach and decrease the risk of vomiting with aspiration.…”