Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a 36 week premature female who was 6 hours old. The pregnancy history was remarkable for polyhydramnios on prenatal ultrasound. Immediately after birth the patient developed bilious emesis.
Clinical Physical Exam:
Aside from some bile on her clothes, the clinical exam was unremarkable
Clinical Differential Diagnosis:
Proximal small bowel obstruction, rule out malrotation and midgut volvulus or duodenal atresia
Abdominal films from the first day of life demonstrated a proximal small bowel obstruction. This was confirmed on an upper GI from later that day, which showed the level of the obstruction to be in the proximal jejunum. The patient was not malrotated.
Images 1 and 2
Images 3 and 4
Imaging Differential Diagnosis:
Diaphragm of the proximal jejunum
An exploratory laparotomy to investigate the cause of the partial proximal small bowel obstruction was performed the next day and revealed jejunal stenosis with an incomplete jejunal web. The jejunal web was excised and a jejunoplasty was performed.
Follow-up and Prognosis:
In the immediate postoperative period the patient had difficulty maintaining her weight on oral feeding, but this resolved over time. The patient has otherwise recovered well.
Case 4, Case 14, Case 20, Case 23
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