Minimal intestinal resection during primary repair of type IV congenital small intestinal atresia

Intestinal resection in type IV small atresia

Abstract

Background: Multiple intestinal resection and anastomosis are common surgery options for type IV jejunoileal atresia, although anastomotic leakage is associated with a 15% mortality rate. Objectives: to describe a surgical approach involving a single intestinal anastomosis bypassed through additional intraluminal obstructions using an intravenous (IV) catheter followed by enteroplasty. Case Report: A six-hour-old low-birth-weight preterm female newborn presented from the neonatal division with bilious vomiting prior to initial feeding, accompanied by generalized abdominal distention. A plain abdominal radiograph revealed the “countable bubble” sign. Exploratory laparotomy was performed and discovered multiple jejunoileal atresia and microcolon. A resection of 20 cm of jejunum, followed by and end-to-oblique jejunal anastomosis, was performed. An IV catheter was used to bypass additional intraluminal obstructions in the jejunum and ileum, followed by jejuno-ileoplasty at the catheter insertion site. Routine rectal irrigations and total parenteral nutrition were administered postoperatively. By five weeks, the patient was able to defecate spontaneously, fully breastfeeding, and discharged from the hospital. Conclusion: The use of an IV catheter to bypass intraluminal obstructions may be an option to avoid multiple intestinal resection and anastomosis in type IV congenital jejunoileal atresia