Membrane resection and Heineke-Mikulicz jejunoplasty for the management of Type-I jejunal atresia: A case series

Abstract

Introduction

Jejunal atresia (JA) is a congenital obstruction of the jejunum typically treated with resection of the atretic segment plus primary anastomosis. As a potential alternative we evaluated the efficacy of a membrane resection plus Heineke-Mikulicz jejunoplasty for the management of type-I JA.

Case series

Case 1) One-day-old male, born at 32 weeks of gestation with a prenatal diagnosis of proximal intestinal obstruction. Postnatal abdominal films showed a double-bubble sign. He underwent an exploratory laparotomy during which a type-1 JA was found 10 cm distal to the ligament of Treitz (LOT). We did a jejunotomy over the site of the atresia, removed the membrane that was causing the obstruction, and closed the jejunotomy in a Heineke-Mikulicz fashion. Case 2) Five-day-old male born at 34 weeks of gestation with a prenatal diagnosis of a proximal intestinal obstruction. Postnatal abdominal films showed a double-bubble sign with distal intestinal gas, suggestive of a fenestrated obstructive membrane. He underwent an exploratory laparotomy during which we found a type-1 JA 5 cm distal to the LOT. He underwent the same procedure described in Case 1. Case 3) Two-day-old female born at 34 weeks of gestation with a prenatal diagnosis of a proximal intestinal atresia. She underwent an exploratory laparotomy during which we found a type-1 JA 20 cm distal to the LOT. She underwent the same procedure described in Case 1, plus tapering of the proximal side of the atresia. Case 4) One-day-old term male with prenatal diagnosis of proximal intestinal obstruction. Postnatal abdominal films showed a double-bubble sign. During the exploratory laparotomy we found a type-1 JA 20 cm distal to the LOT. We did the procedure described in Case 1. All patients tolerated the operation well. The time to reach full enteral feedings ranged from 17 to 53 days. One patient required an exploratory laparotomy with lysis of adhesions 28 days after the initial operation. All cases had prenatal diagnoses of intestinal atresia (IA) and followed a standardized protocol involving orogastric tube (OGT) placement, X-ray imaging, neonatal intensive care unit (NICU), and laparotomy. Obstruction was treated via longitudinal enterotomy, membrane resection and HMJ. Patients tolerated full oral intake within 17–53 days and no mortality was observed.

Conclusion

Membrane resection and HMJ seems to be a safe and effective option for the management of type-I JA.