Late presentation of type-I jejunal atresia in an infant: A case report

Introduction

Intestinal atresia is an uncommon cause of intestinal obstruction. In the vast majority of the cases, signs and symptoms develop early in the neonatal period. Presentations beyond the neonatal period are rare.

Case presentation

A former premature female infant who was otherwise healthy developed recurrent, non-bilious vomiting associated with feedings at the age of 8 months. Up until that time her weight gain had been appropriate, and she had regular bowel movements. Over the course of the following weeks, the vomiting became more frequent. A few days after her 9-month well-child visit during which she still appeared to be in good health, her vomiting turned bilious and was not related to feedings. Her parents brought her to the emergency room. She was admitted to the hospital and underwent imaging studies to investigate the source of what seemed to be an intestinal obstruction. The upper gastrointestinal series (UGI) showed delayed passage of contrast, and a caliber change in the proximal small bowel. The computerized tomography (CT) confirmed the findings, which were suggestive of a partial proximal intestinal obstruction. She underwent a laparotomy. We identified an area of caliber change 15 cm distal to the ligament of Treitz. We opened the proximal side and identified a jejunal membrane that had a pinhole opening in the center. We resected a 4-cm segment of jejunum that included the caliber transition and the membrane and did an end-to-end anastomosis. She tolerated the operation well and was discharged home 12 days later. At the age of 1 year, she is thriving well.

Conclusion

Although type-I jejunal atresia typically presents in the neonatal period, it should be included in the differential diagnosis of infants with recurrent vomiting and signs of a partial bowel obstruction.