Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a term male, 1 day old. Prenatal ultrasound performed just before birth for antenatal fluid assessment demonstrated dilated loops of bowel in the fetus. After delivery the child was found to have a distended abdomen and a nasogastric tube was placed and 100 cc of bilious material was aspirated from the stomach
Clinical Physical Exam:
Clinical Differential Diagnosis:
Proximal bowel obstruction - malrotation with midgut volvulus, duodenal atresia, jejunal atresia
An abdominal film from the first day of life demonstrated a proximal small bowel obstruction, and this was confirmed on an upper GI performed exam later on the same day. A barium enema from the same day demonstrated a fairly normal caliber colon.
Imaging Differential Diagnosis:
On the second day of life the patient had an exploratory laparotomy via a transverse supraumbilical incision. Upon entering the abdomen the proximal jejunum was prominently dilated with a blind end. Distally, an apple-peel deformity with extensive jejunal and ileal atresia was encountered. The ileum was spiraled around the ileocolic artery. The most proximal 5-6 cm of ileum was quite dusky and nonviable in appearance. The small bowel measured only 50 cm in length. The ileocecal valve and colon were unremarkable. The patient had a tapering enteroplasty of the bowel proximal to the atretic segment, a partial small bowel resection and an end-to-end enteroenterostomy.
Apple Peel Atresia of Small Bowel
Follow-up and Prognosis:
There was concern that the patient would develop a short gut syndrome. Postoperatively the patient showed signs of persistent bowel obstruction and 2 months after the initial surgery the patient had an exploratory laparotomy with lysis of adhesions. At that time, the patient was noted to have an area of stricture in the small bowel 4 cm distal to the previous area of end to end anastomosis and this stricture was resected. The patient has since done well.
Case 4, Case 6, Case 14, Case 18, Case 20
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