Jejunal atresia

Case contributed by Dr Jane McEniery

Presentation

Newborn, born at 36 weeks. Abdominal distension and vomiting on day 1 of life. Large volume bilious aspirates from NGT.

Patient Data

Age: newborn (0 days)
Gender: Female
X-ray
  • gastric tube, tip in the stomach
  • gaseous distension of bowel loops in the left upper quadrant, likely within stomach, duodenum and proximal jejunum
  • no visible gas in distal small bowel or projecting over the rectum
  • no pneumoperitoneum
  • lungs and pleural spaces are clear
  • normal heart size
Fluoroscopy

Contrast enema shows:

  • rectal catheter in situ, balloon inflated
  • gastric tube with tip in the gastric body
  • increased caliber of gas filled, dilated proximal small bowel loops compared with the prior x-ray
  • rectum of normal caliber, with normal rectosigmoid ratio
  • contrast opacification of the colon and ileum 
  • the colon is small without abrupt focal change in caliber 
  • contrast does not enter the dilated loops of small bowel
  • no evidence of perforation

Case Discussion

The most likely diagnosis in this case (subsequently confirmed surgically) is jejunal atresia.
Differentials for this appearance include multifocal small bowel atresias.

Urgent surgical referral is required.


Case contributed by Dr Craig Ferguson.

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