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

Abstract

Background:Â Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejunal atresia occurs more frequent than duodenal or colonic atresias while single atresias are most commonly encountered. Jejunal atresia is classified into 4 types: Type I (a mucosal/septal), Type II (a fibrous cord/band), Type III (blind ends are entirely separated without a fibrous cord between them and a large mesenteric defect), and Type IV (combination of atresia type I to III). This study aims to elaborate jejunal atresia in the newborn after resection and end-to-end anastomoses.Case Description:Â We report three cases of jejunal atresia consists of different types: type IV (first case), type IIIa (second case) and type I (third case). Cases were neonates born with signs of upper gut obstruction. Bile-stained vomiting was reported a few hours after birth and failed to pass meconium in the first 24 hours. Postnatal abdominal X-ray showed dilatation of the gaster and no gas present in the pelvic floor. In the third case, it showed a triple bubble sign on abdominal x-ray and a laparotomy revealed the type of jejuno-ileal atresia. Also, the resection on the atresias and end to end anastomosis were performed. Cases were admitted to neonatal intensive care unit with total parenteral nutrition. The first two cases died due to sepsis, while the third case survived.Conclusion:Â Jejunal atresia is a rare disease among newborn. All of the patients have provided resection and end-to-end anastomoses, although 2 of them did not survive.Â

Midgut Atresia: Diagnostic and Management Challenges From Northern Tanzania

“…13 Antenatal sonography and magnetic resonance imaging (MRI) can be used to diagnose intestinal atresia in the fetal period by the presence of dilated bowel loops and polyhydramnios; hence it is important to elicit such history from the caretakers if they underwent obstetric ultrasound during their pregnancy. 11,14 From our experience, none of the caretakers could give the details of the obstetric ultrasound. Abdominal ultrasound and plain abdominal X-rays can aid in confirming the diagnosis of atresia by the presence of "double-bubble" sign or "triple-bubble" sign on an erect plain abdominal X-ray as evident in cases 3, 4, and 5.…”

“…Other features include jaundice in about a third of the cases, as in cases 2 and 4, and failure to pass meconium in the first 24 hours of life. 11 Radiological evaluation is required, and early surgical management improves the outcome and minimizes complications. 11 Surgical management depends on the type of atresia.…”

“… 11 Radiological evaluation is required, and early surgical management improves the outcome and minimizes complications. 11 Surgical management depends on the type of atresia. 12 From our experience, there is a delay in presentation to tertiary centers, leading to poor outcome and increased mortality.…”

“…Abdominal ultrasound and plain abdominal X-rays can aid in confirming the diagnosis of atresia by the presence of “double-bubble” sign or “triple-bubble” sign on an erect plain abdominal X-ray as evident in cases 3, 4, and 5. 11 …”

“…Abdominal ultrasound and plain abdominal X-rays can aid in confirming the diagnosis of atresia by the presence of "double-bubble" sign or "triple-bubble" sign on an erect plain abdominal X-ray as evident in cases 3, 4, and 5. 11 A review by Miscia et al showed that open surgery was the preferred mode of surgical intervention in correcting duodenal atresia compared to the laparoscopic method. This is because it is easier to look for missed intestinal atresia in open surgery than in laparoscopy.…”