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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 6

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 6

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Newborn 36 week premature female with bilious vomiting.

Clinical History:
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 Labs:

Clinical Differential Diagnosis:
Proximal small bowel obstruction, rule out malrotation and midgut volvulus or duodenal atresia

Imaging Findings:
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.

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Imaging Differential Diagnosis:
Diaphragm of the proximal jejunum

Operative Findings:
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.

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Pathological Findings:

Final Diagnosis:
Jejunal Web

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.

Similar Cases:
Case 4, Case 14, Case 20, Case 23


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