Longitudinal enteroplasty as a method of primary treatment in newborns with proximal jejunal atresia

Abstract

The proximal segment in case of intestinal atresia is blind-ended, dilated and hypertrophied, has no effective peristalsis. This leads to the development of small intestinal bacterial overgrowth syndrome, malabsorption and poor adaptation of the small intestinal ends during enteroenterostomy. A typical approach to surgical correction of intestinal dilatation is resection of the dilated segment. Real challenges occur if a sufficient intestinal resection impossible due to the short proximal segment or if such a resection may lead to the development of short bowel syndrome. This article describes the clinical case of jejunal atresia in a newborn. The abnomality was diagnosed using prenatal ultrasound. The fetal follow-up examination included prenatal ultrasound monitoring. The baby is delivered by vaginal birth, at 38 weeks of gestation. Surgical treatment for diagnosed congenital abnormality was performed in 8 hours after birth. During the surgery, a jejunal atresia was found at the level of 7 cm from the Treitz’s ligament. The proximal segment of jejunum was dilated up to 3.5 cm and passed into a narrowed (up to 0.6 cm) distal one. After the enterotomy, a perforated membrane of the jejunum was found. A longitudinal tapering enteroplasty of the proximal intestinal segment to the level of Treitz’s ligament was conducted, after which an anastomosis was carried out. After the conducted surgery, the signs of organic and functional intestinal obstruction were not observed, and full enteral nutrition was achieved. The outcomes of conducted surgical treatment are good. Proposed tactics and strategy of proximal jejunal atresia surgical management is efficient and may be used if it is found impossible to perform a sufficient extent of small intestine resection or preserve its original length.