The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn.

Zachary Bauman,Victor Nanagas

doi:10.1155/2015/129098

Zachary Bauman, Victor Nanagas

Open Access

https://doi.org/10.1155/2015/129098

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Abstract

We encountered a rare case of gastroschisis associated with jejunal atresia and colonic atresia. In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure. The colonic atresia was not discovered for 48 days after initial repair of the gastroschisis secondary to the rarity of the disorder. Both types of atresia were repaired with primary hand-sewn anastomoses. Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course. Based on our case presentation, small bowel atresia and colonic atresia must be considered in patients who undergo abdominal wall closure for gastroschisis with prolonged symptoms suggestive of bowel obstruction. Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

Highlights

Atresia of the colon is an uncommon cause of intestinal obstruction in the newborn patient, with classic etiologic factors resulting from intrauterine mesenteric vascular obstruction associated with internal hernia, volvulus, intussusception, or strangulation in tight gastroschisis [1]
The bowel was followed to the colon where we discovered type II transverse colonic atresia, which is when the blind ends of bowel are separated by a fibrous cord [1]
Similar to the review by Kronfli et al, our missed intestinal atresia patient continued to demonstrate abdominal distension with prolonged feeding intolerance and high nasogastric tube output [5]. Able to recognize this obstructive jejunal atresia within 27 days of life, as opposed to the 41–57-day range cited in this review [5]

Summary

Introduction

Atresia of the colon is an uncommon cause of intestinal obstruction in the newborn patient, with classic etiologic factors resulting from intrauterine mesenteric vascular obstruction associated with internal hernia, volvulus, intussusception, or strangulation in tight gastroschisis [1]. It occurs between 1.8 and 15 percent of all patients affected by atresia of the bowel, with most studies quoting less than 10 percent of patients reviewed [2]. We report an even greater rarity in which a patient born with a known gastroschisis was later found to have both jejunal atresia and colonic atresia

Case Report

Discussion

Findings

Conflict of Interests