This document describes a case of jejunoileal atresia in a preterm infant girl. At 7 days old, she presented with bilious vomiting and abdominal distension. Imaging revealed dilated bowel loops in the upper abdomen and collapsed segments in the lower abdomen, consistent with jejunoileal atresia. During exploratory laparotomy, multiple atretic segments involving the jejunum and ileum were found. The infant underwent an end-to-side jejunoileal anastomosis. Post-operatively, she received total parental nutrition and antibiotics for infection. Her bowel function gradually returned over a month as she was transitioned off TPN to full oral feeds. Jejuno

1. B owel Wobble-
Jejunoileal Atresia
MANOJ KUMAR
PGT, INSTITUTE OF CHILD HEALTH

2.  7days
 Girl
 Preterm 32 weeks, LUCS
 Birth weight-1.7kg
 Bilious vomiting, progressive abdominal distension since Day-2 of life
 Meconium passed at 20 hrs of life.

3. On examination:
 Weight on admission 1.5kg
 Lethargic
 Dehydrated
 Abdomen- distended,
 Bowel loops visible
 IPS sluggish

4. Initial investigations:
 Hb-14.4 gm%
 TLC -11600/mm3, N-67% L26%
 CRP-3.0 mg/L
 Na+ 129
 K+ 4.6
 After phototherapy –
 Total bilirubin -8.1 mg/dl
 Total Bilirubin-19 mg/dl
 Conjugated bilirubin-1.06 mg/dl
 Total Protein -5.2 g/dl
 Albumin-3.7 g/dl
 Initial blood culture-negative

5. Imagining:
 X Ray Abdomen (AP erect)

6. Ultrasound abdomen:
 Abnormally dilated bowel loops in upper abdomen
 Collapsed segments in lower abdomen

7. Contrast study:

8.  Exploratory laparotomy was done
 Findings–Dilated stomach and duodenum
2cm blind ending jejunum
Apple peel jejuno ileal atresia
Multiple atretic segments involving jejunum and ileum
 Dignosis- Type III B jejuno ileal atresia
 End to side jejuno ileal anastomosis

9. Intra-operative findings:
Apple peel atresia
Multiple atresia11cm distal ileum
Distended proximal 2cm
jejunum

10. Apple peel jejunoileal atresia associated
with-
 Prematurity ( 70% )
 Low birth weight ( 70% )
 High rate of malrotations ( 54% )

11. Post operative management
 Total parental nutrition-
 Aminoven- 3.5 g/kg/day
 SMOFLIPID 20% started with 1 g/kg/day & then increased to 3 g/kg/day
 multivitamins added
 Fluid & electrolytes balance
 Continuous RT sucton + mannual suction
 Repeat blood culture – Klebsiella pneumoniae
 Inj Meropenum & Colistin for 14 days
 Post OP monitoring – CBC, electrolytes, blood gas, Triglyceride level, LFT ,Anthropometry

12.  Triglycerides level after 7 days of TPN was 226 mg/dl
 SMOF lipid stopped for 2 days & then restarted (repeat TG level was
110 mg/dl )
 Bowel function retured after 1 month started with small amounts of clear oral
liquids, slowly transitioned to oral feeds & TPN stopped.

13. Morbidity & mortality
 Infections- pneumonia , sepsis, peritonitis
 Functional intestinal obstruction , anastomotic leak
 Jejuno ileal atresia with gastroschisis & short bowel syndrome
 Before 90’s mortality rate was 71%
 1985 to 2001 –overall survival rate 80-90%