Small Bowel Atresia Research Articles

Retrospective review of growth in pediatric intestinal failure after weaning from parenteral nutrition.

Growth outcomes in children with intestinal failure (IF) after weaning from parenteral nutrition (PN) may be modified by primary diagnosis and interventions aimed at achieving enteral tolerance. We evaluated growth after weaning by diagnosis and intestinal transplant status and during treatment with the glucagon-like peptide-2 analog teduglutide. A two-center retrospective review was conducted on children diagnosed with IF at age <12 months. The z scores for weight and length/height were examined up to 5 years after PN weaning and in children who received teduglutide for >6 months. Data were reported as median and interquartile range (IQR). A total of 362 children (58% male and 72% White) were reviewed; 41% (n = 150) weaned from PN at age 1.5 years (IQR = 0.96-3). Weight and length/height data were available for 144 children; 46 received an intestinal transplant. Median weight and length/height z scores at weaning were -1.15 (IQR = -2.09 to -0.39) and -1.89 (IQR = -2.9 to -1.02), respectively. In those not transplanted, z scores remained stable (± 0.5 change). Children with small bowel atresia experienced accelerated linear growth (> +0.5 change) beginning in year 3. Most children transplanted experienced growth acceleration beginning in year 2. Fourteen children received teduglutide (median = 840 [IQR = 425-1530] days), and growth remained stable throughout treatment. Five were weaned from PN within 1 year. We observed stable growth with limited catch-up after PN weaning, with minimal variation by diagnosis, and during teduglutide therapy. Children who received an intestinal transplant experienced acceleration in weight and linear growth after weaning.

Decisions in Diversion: Enterostomy vs. Primary Anastomosis for Colonic Atresia

BackgroundColonic atresia (CA) is associated with Hirschsprung disease (HD) in up to 10% of cases. Therefore, some surgeons elect to complete proximal diversion at the initial operation. We sought to better define the incidence of concurrent HD and evaluate practice patterns regarding diversion for CA. MethodsThe Pediatric Health Information System (PHIS) database was used to identify patients with CA from 2013 to 2022. Patients with small bowel atresia, anorectal malformation, gastroschisis, or first operation after 14 days of age were excluded. Index and subsequent operations were defined. Complications, time to enterostomy closure, and unplanned operations were evaluated. ResultsHD was diagnosed in 8 (9.5%) patients and 7 of these were initially diverted. Diverted and anastomosed patients were demographically similar. In the 58 (69%) patients initially diverted, 19 (33%) had an ileostomy. Continuity was restored with an ileo-colic anastomosis in 63% of diverted and 27% of primarily anastomosed patients. Of those initially managed with a colostomy, 53% ultimately had a colo-colonic anastomosis. Patients with primary anastomoses had fewer operations and received more days of parenteral nutrition. Other outcomes did not vary. ConclusionIn a large population of infants with CA, 9.5% had concurrent HD. Almost 70% of CA patients underwent initial diversion and only one with HD had a primary anastomosis. Patients managed with a primary anastomosis were substantially more likely to retain the proximal colonic segment, but had a similar incidence of complications. When intraoperative colonic biopsies are obtained, primary anastomosis is a safe and effective strategy for CA. Level of Evidence3.

Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction

Background:: Fetal small bowel obstruction (SBO) is a serious condition with high morbidity and mortality rates. Prenatal ultrasound is an important tool for detecting SBO, but the optimal cutoff value for intestinal diameter remains undefined. Objective:: This study aimed to investigate the ultrasonic characteristics of fetal SBO and determine the optimal cutoff value for intestinal diameter to enhance prenatal ultrasound diagnosis. Methods:: We retrospectively analyzed the ultrasonic characteristics and postpartum data of 76 cases diagnosed with SBO. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for dilated intestinal diameter. Results:: Among the 76 cases, 31 displayed the “double bubble sign” on ultrasound, with 20 cases identified as annular pancreas, 6 as duodenal atresia, and 5 as duodenal membranous stenosis. In 45 cases, the lesions were located in the jejunal or ileal segment and exhibited intestinal dilatation above the lesion site, including 27 cases of small bowel atresia, 7 cases of membranous jejunal stenosis, and 11 cases of small bowel volvulus. Out of the 76 cases, 9 showed no abnormalities after birth. ROC curve analysis determined optimal cutoff values of 17.5mm and 10.5mm for predicting “double bubble sign” lesions in the gastric and duodenal widths. For predicting small intestinal dilatation, the optimal cutoff values for dilated width and length of the intestinal tube were 11.5mm and 21.5mm, respectively, with high sensitivity and specificity. Conclusion:: Ultrasonic imaging and changes in intestinal diameter provide valuable information for prenatal diagnosis and management of SBO. Establishing these cutoff values can improve the accuracy of prenatal ultrasound diagnosis for SBO.

EP10.13: Investigation of the obstructive site and prenatal ultrasound features in fetal small bowel atresia

EP10.13: Investigation of the obstructive site and prenatal ultrasound features in fetal small bowel atresia

A rare cause of neonatal feeding intolerance: congenital segmental intestinal dilatation—a case report

BackgroundCongenital segmental intestinal dilatation (CSID) is a rare cause of neonatal bowel obstruction. Patients can present in the early newborn period with feeding intolerance and abdominal distension. Diagnosis is challenging due to its rarity and non-specific clinical and radiological findings in a well neonate. Surgical excision remains the mainstay treatment for this disease.Case presentationWe report a case of a newborn male with congenital segmental ileal dilatation, who presented with abdominal distension and feeding intolerance. He was born preterm at 32 weeks and was treated for presumed sepsis due to a premature rupture of the membrane. The patient developed persistent abdominal distension upon initiation of feedings with large amount of gastric aspirates. Otherwise, there was no delay in the passage of meconium. Serial abdominal radiographs showed persistent focal bowel dilatation on the right side. He was initially diagnosed with small bowel atresia. Ultrasound abdomen and lower gastrointestinal contrasted study showed focal ileal dilatation with no evidence of pneumoperitoneum. Intraoperative findings revealed a segmental ileal dilatation with no evidence of mechanical obstruction. The abnormal dilated bowel was excised and sent for histopathological examination. He recovered well after surgery.ConclusionDiagnosis of CSID can be challenging due to its clinical polymorphism and non-specific radiological findings. CSID should be suspected in neonates with feeding intolerance and focal intestinal dilatation without clinical features of sepsis, peritonitis, or mechanical obstruction. Surgical excision is curative with a good outcome.

Location of Treatment Among Infants Requiring Complex Surgical Care

IntroductionRural children have worse health outcomes compared to urban children. One mechanism for this finding may be decreased access to specialized care at children's hospitals. The objective of this study was to evaluate the hospital types where complex surgical care in infants is performed nationally. MethodsThis study examined infants (<1 y old) in the Kids' Inpatient Database from 2009 to 2019 who underwent surgery for one of the following conditions: esophageal atresia, gastroschisis, omphalocele, Hirschsprung disease, anorectal malformation, pyloric stenosis, small bowel atresia, congenital diaphragmatic hernia, and necrotizing enterocolitis. The relationship between patient residence (rural versus urban) and location of surgical care (children's hospital versus other) was compared in relation to other covariates using multivariable logistic regression models. ResultsAmong 29,185 infants undergoing these operations, 16.0% lived in a rural area. Rural infants were more frequently White (64.8% versus 43.4% P < 0.001), from the lowest two income quartiles (86.5% versus 52.0%, P < 0.001), and from the South or Midwest regions (P < 0.001). Surgical care was predominantly (94.1%) provided at urban teaching hospitals but frequently not at children's hospitals, especially among rural infants. After adjusting for other covariates, rural infants were significantly less likely to undergo care at a children's hospital for both 2009 (adjusted odds ratio 0.66, P < 0.001) and 2012-2019 (adjusted odds ratio 0.78, P < 0.001). ConclusionsA sizable portion of complex surgical care in infants is performed outside children's hospitals, especially among those from rural areas. Further work is necessary to ensure adequate access to children's hospitals for rural children.

A nordic multicenter study on contemporary outcomes of pediatric short bowel syndrome in 208 patients

Despite advances in the management of short bowel syndrome related intestinal failure (SBS-IF), large-scale contemporary pediatric studies are scarce. The aim of this multicenter study was to assess key outcomes and clinical prognostic factors in a recent Nordic pediatric SBS-IF population. Patients with SBS-IF treated during 2010-2019, whose parenteral support (PS) started at age <1 year and continued >60 consecutive days were included and retrospectively reviewed. All six participating centers followed multidisciplinary SBS-IF management. Risk factors for PS dependency, intestinal failure associated liver disease (IFALD) and mortality were assessed with Cox regression and Kaplan Meier analyses. IFALD was defined with serum liver biochemistry levels. Among 208 patients, SBS-IF resulted from NEC in 49%, gastroschisis w/wo atresia in 14%, small bowel atresia in 12%, volvulus in 11%, and other diagnoses in 14%. Median age-adjusted small bowel length was 43% (IQR 21-80%). After median follow up of 4.4 years (IQR 2.5-6.9), enteral autonomy was reached by 76%, none had undergone intestinal transplantation, and overall survival was 96%. Half of deaths (4/8) were caused by septic complications. Although biochemical cholestasis occurred only in 3% at latest follow-up and none of deaths were directly caused by IFALD, elevated liver biochemistry (HR 0.136; P=0.017) and shorter remaining small bowel (HR 0.941; P=0.040) predicted mortality. Shorter remaining small bowel and colon, and presence of end-ostomy were the main predictors of PS dependency, but not IFALD. Patients with NEC reached enteral autonomy more efficiently and had decreased incidence of IFALD compared to other etiologies. Although with current multidisciplinary management, prognosis of pediatric SBS is encouraging, septic complications and IFALD still associated with the remaining low mortality rate.

Teduglutide therapy in a child with short bowel syndrome

Introduction. Short bowel syndrome (SBS) in children is a rare disease. One of the most common etiological factors for the development of SBS in children is atresia of the small intestine. After surgical correction of the congenital anomaly, the remaining intestine attempts to increase absorption to restore homeostasis, and the process of intestinal adaptation begins. This process of adaptation can be assisted with analogues of endogenous growth factors of the intestine, such as teduglutide. Case outline. This report presents ? girl, aged two years and eight months, who had an estimated 20 cm of small intestine after surgical correction of congenital small bowel atresia and clinical signs of SBS. She was repeatedly hospitalized due to frequent need for parenteral correction of fluid, electrolyte, and nutrient imbalances. Stagnation in body weight and slow growth in body height were accompanied by weakened gross motor strength and slowed psychophysical development. After exploit conservative treatment measures, stimulation of intestinal adaptation was initiated with the drug teduglutide. After six months of drug therapy, progress was observed in body parameters, as well as an increase in intelligence quotient and motor abilities. Conclusion. SBS is a challenging entity for every clinician, and its previous therapy has mainly consisted of parenteral substitution of nutrients, fluids, and electrolytes. Surgical treatment carries the risk of loss of the remaining bowel and lifelong immunosuppression. The pharmacological possibilities of promoting intestinal adaptation using drugs such as teduglutide represent a light at the end of the tunnel for patients with SBS.

Diagnostic value of the microcolon using ultrasonography in small bowel atresia

BackgroundMicrocolon helps diagnose small bowel atresia (SBA) using contrast enema. However, there are no ultrasonography (US) microcolon criteria for diagnosing SBA. Therefore, this study aimed to evaluate colon accuracy and other characteristics for diagnosing SBA by US, using surgical or clinical information as the reference standard.MethodsUS was performed on 46 neonates aged ≤ 7 days old. In the study group (n = 15), neonates with SBA were confirmed following surgery. In the study group without SBA (n = 15), neonates with other gastrointestinal problems besides SBA were confirmed by surgical or clinical follow-up. Sixteen neonates without gastrointestinal problems were classified as the control group. The colonic diameter was measured, and colonic gas was sought and observed. Statistical analysis was performed to compare US parameters between the study group and other two groups. The optimal cut-off value of the colonic diameter for SBA diagnosis was obtained using receiver operating characteristic analysis.ResultsColonic diameters (0.5 cm) in the study group (interquartile ranges [IQR], 0.5–0.6 cm) was significantly smaller than that in the group without SBA (0.9 cm; IQR, 0.8–1.2 cm) (P < 0.001) and in the control group (1.2 cm; IQR, 0.8–1.35 cm) (P < 0.001). Optimum cut-off value for diagnosing SBA was 0.65 cm (sensitivity, 90.3%; specificity, 86.7%; accuracy, 89.1%) for the colonic diameter. Combining microcolon and gas-negativity showed the best performance in SBA diagnosis using US, with increased accuracy (91.3%).ConclusionA colon < 0.65 cm in diameter should be called a microcolon; combining US with gas-negativity is an essential diagnostic basis for SBA.

Diagnostic challenge of concomitant small bowel atresia and Hirschsprung's disease

The incidence of ileal atresia ranges from 1/5000 to 1/12000 births. The incidence of Hirschsprung's disease is 1/5000. The combination of Hirschsprung disease and ileal atresia during infancy seems to be a rare event and the exact incidence of the association of the two malformations remains unknown. Several embryo-pathological theories have been offered to explain the correlation of these two malformations. Some of them state that atresia would be a consequence of aganglionnosis and some others the contrary. The urgency of an early detection of this associations is related to her increased morbidity during management, especially if part of the phenotype remains unidentified. To date, less than 25 case of ileal atresia associated with Hirschsprung's disease are reported in Literature. We present two cases managed in our department initially for ileal atresia. Diagnosis of total colonic Hirschsprung's disease associated was placed later, after the appearance of an intestinal occlusion at the time of the restoration of digestive continuity. The first case was derived three times, and the second twice before becoming digestive self-sufficient. The dysfunction of the anastomosis after restoration of continuity is a dangerous complication which underlines the interest of the early diagnosis of the association ileal atresia and Hirschsprung's disease. It is necessary to have the rectal biopsy early, especially when the patient continues to exhibit poor bowel function after corrective surgery.

Factors Affecting Survival in Patients with Small Bowel Atresia and Stenosis

Amaç: İnce barsak atrezi/stenozu nedeniyle takip edilen hastaların morbidite ve mortalite nedenlerini ve sağ kalımı etkileyen faktörleri araştırmak, büyüme ve gelişmelerini incelemektir.&#x0D; Gereç ve Yöntemler: 2002-2012 yılları arasında duodenal, proksimal jejunoileal, distal jejunoileal atrezi/stenoz nedeniyle takip edilen 85 hasta çalışmaya dâhil edildi. Hastaların cinsiyeti, prenatal tanısı olup olmadığı, tanı konulma zamanı, doğum haftası, kilosu, anne yaşı, klinik özellikleri, eşlik eden anomaliler, ameliyattaki bulgular, ameliyat sonrası hastanede kalış süresi ile ilgili veriler kaydedilerek morbidite ve mortaliteyi etkileyen faktörler ve büyüme gelişme parametreleri incelendi.&#x0D; Bulgular: Çalışmaya dâhil edilen 85 hastanın 44’ü kız, 41’i erkekti. Hastaların 35’inde duodenal, 29’unda proksimal jejunoileal, 21’inde ise distal jejunoileal atrezi/stenoz mevcuttu. Hastaların %58’inde prematürite mevcuttu. Duodenal atrezi/stenozu olan hastalarda eşlik eden konjenital anomali oranı %74,&#x0D; jejunoileal atrezi/stenozu olan hastalarda %42 idi. Çalışma grubunda mortalite oranı %18, erken ve geç dönem komplikasyon oranı %20 olup, en sık görülen komplikasyon sepsisti. Mortalite ile sonuçlanan hastalarda eşlik eden konjenital anomali varlığı (%100), düşük doğum ağırlığı (%93) ve prematürite sıklığının (%80) artmış olduğu görüldü. Hastalar büyüme gelişme açısından incelendiğinde duodenal atrezi/stenoz grubunda vücut ağırlığı ve kilo persentillerinin normal değerlerde olduğu, jejunoileal atrezilerde ise boy persentillerinin düşük olduğu tespit edildi.&#x0D; Sonuç: İnce barsak atrezisi/stenozu nedeniyle tedavisi yapılan ve kaybedilen hastalarda prematürite, düşük doğum ağırlığı ve eşlik eden konjenital anomali sıklığının artmış olduğu bulunmuştur. Geç dönem komplikasyon oranının düşük olmasının, hastalardaki takip düzensizliğine bağlı veri eksikliğinden kaynaklandığı düşünülmüştür. Jejunoileal atrezi/stenozu olan hastalarda boy persentilleri düşük olup çalışma grubundaki tüm hastaların ameliyat sonrası dönemde beslenme ve büyüme-gelişme açısından yakın takip edilmesini öneriyoruz.

Ileal atresia associated with omphalocele

Omphalocele and Gastroschisis are the two primary most common congenital abdominal wall surgical problems encountered in neonates. Omphalocele has a relatively high incidence of associated defects, the severity and number of which determine the outcomes. The occurrence of intestinal atresia, mostly jejunal and ileal, has been documented in gastroschisis, but there are few literatures describing small bowel atresia associated with omphalocele.

Small-bowel atresias: a case series with review of the disease and imaging findings

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

Bowel Resection Through a Single Umbilical Incision: A Case Series.

Background: The advent of laparoscopy has revolutionized surgery. The surgeon strives to minimize incisions and their adverse consequences. Although laparoscopy has gained widespread popularity, several advantages in open surgery are thereby lost. Tactile sensation of the tissue, hand-sewn anastomosis, and nonthermic vascular control are most prominent. To combine both approaches, single incision laparoscopic-assisted surgery (SILS) was advanced, trying to combine the best in both worlds. This approach is widely used in appendectomies. After having gained experience in this approach, we expanded the indications and hereby present our experience with bowel resections utilizing SILS. Patients and Methods: Data were collected retrospectively from operations performed during the past 3 years. We found 11 cases of SILS bowel resections: 3 sigmoidectomies, 3 small bowel atresia repairs, 1 subtotal colectomy, 1 Meckel's diverticulectomy, and 3 resections of bowel duplications. The age of the patients ranged from 2 days to 17 years. In all cases, a working 10 mm scope was inserted through the umbilicus, the bowel was extracted outside the abdomen through the umbilicus, dissection and resection with anastomosis were performed outside the abdomen in the classic open approach, and the bowel was returned to the abdomen. Results and Conclusions: All patients recovered promptly with no need for further intervention. There were no cases of wound infection, leak, or intra-abdominal abscess formation. Cosmesis was excellent with a small umbilical scar. We conclude that this approach is feasible and safe in a select population.

A de novo ACTB gene pathogenic variant in identical twins with phenotypic variation for hydrops and jejunal atresia

The beta‐actin gene (ACTB) encodes a ubiquitous cytoskeletal protein, essential for embryonic development in humans. De novo heterozygous missense variants in the ACTB are implicated in causing Baraitser–Winter cerebrofrontofacial syndrome (BWCFFS; MIM#243310). ACTB pathogenic variants are rarely associated with intestinal malformations. We report on a rare case of monozygotic twins presenting with proximal small bowel atresia and hydrops in one, and apple‐peel bowel atresia and laryngeal dysgenesis in the other. The twin with hydrops could not be resuscitated. Intensive and surgical care was provided to the surviving twin. Rapid trio genome sequencing identified a de novo missense variant in ACTB (NM_00101.3:c.1043C>T; p.(Ser348Leu)) that guided the care plan. The identical variant subsequently was identified in the demised twin. To characterize the functional effect, the variant was recreated as a pseudoheterozygote in a haploid wild‐type S. cerevisiae strain. There was an obvious growth defect of the yACT1 S348L/WT pseudoheterozygote compared to a yACT1 WT/WT strain when grown at 22°C but not when grown at 30°C, consistent with the yACT1 S348L variant having a functional defect that is dominant over the wild‐type allele. The functional results provide supporting evidence that the Ser348Leu variant is likely to be a pathogenic variant, including being associated with intestinal malformations in BWCFFS, and can demonstrate variable expressivity within monozygotic twins.

Bowel Gangrene in Neonate Born to COVID Mother – Is it a Manifestation of Multisystem Inflammatory Syndrome in Newborn?

Aims: Pregnant mothers with SARS-CoV2 infection are postulated to transfer anti-COVID-19 antibodies to their fetus, which may lead to cytokine storm and fetal inflammatory syndrome, similar to multisystem inflammatory syndrome in children (MIS-C). Manifestations of this newly emerging entity are not elucidated, but MIS in Newborn (MIS-NB) must be suspected whenever a neonate born to COVID positive mother is presenting with unusual symptoms.&#x0D; Clinical Description: We report a preterm, low birth weight, Monochorionic Diamniotic (MCDA) twin neonate born to COVID positive mother who developed abdominal distension in first few hours of life, initially suspected to have small bowel atresia. Baby had elevated inflammatory panel and given IVIG, suspecting MIS-NB. Intraoperatively the baby was noted to have gangrenous bowel, which required extensive surgical resection, but baby succumbed postoperatively.&#x0D; Conclusion: This report highlights possible intestinal manifestations of possible COVID-19 related fetal inflammatory syndrome.

Early parenteral nutrition for preterm infants: perhaps more complicated than it first appears

Since its first neonatal application in an infant with small bowel atresia in 1968,1 parenteral nutrition (PN) has become a key tool in the management of preterm infants, and has...

Meconium peritonitis: A 22-year review in a tertiary referral center

BackgroundMeconium peritonitis (MP) is a sterile, chemical peritonitis resulting from in-utero fetal bowel perforation. Severe cases may lead to serious morbidities and mortalities. ObjectiveTo review the common antenatal ultrasound abnormalities associated with MP, and identify radiological and clinical prognostic factors. Materials and methodsRetrospective review of all neonates with MP from January 1997 to December 2019 treated in our hospital was performed. Antenatal ultrasound findings, clinical presentations and outcomes were analyzed. ResultsThirty-five neonates (17 males, 18 females) were included in the study. Thirty-two (91.4%) attended antenatal screening, and 27 (84.4%) of them had abnormalities identified on antenatal ultrasound. The most common abnormality was polyhydramnios (43.8%). Nineteen (54.3%) patients were inborn. Twenty (57.1%) patients were born prematurely. Laparotomy was required in 85.7% of patients. The median time to laparotomy was shorter in the inborn group [1 day (0–9 days) vs 4 days (2–34 days), p = 0.001], but the duration of post-operative hospital stay was comparable [71 days (16–423 days) vs 73.5 days (23–231 days)]. However, such duration was found to be significantly longer in the pre-term group when compared to full-term [58.5 days (16–89 days) vs 85 (21–423 days), p = 0.01]. The most common pathology was small bowel atresia and there were two mortalities. ConclusionDue to the advancement in prenatal detection, pediatric anesthesia, intensive care and surgical techniques, the morbidity and mortality of MP has much decreased. Effective multi-disciplinary antenatal counseling facilitated the perinatal management of MP and resulted in comparable prognosis and outcome in inborn and outborn neonates. Level of evidence3

Percutaneous catheter decompression in a neonate with multiple small bowel atresias

The management of infants with multiple intestinal atresia and complex gastroschisis can represent a challenge to the paediatric surgeon. This case report presents a neonate with multiple jejunal atresias in which a percutaneous foley catheter tube inserted to just beyond the duodenojejunal flexure was used effectively for bowel decompression, instead of the formation of a proximal stoma. By utilising this technique, the well documented complications associated with proximal stomas were avoided, bowel length was preserved and the need for further surgery in the infant was prevented. The infant remained well at six months with no complications at follow-up.

New sonographic feature (C-sign) to improve the prenatal accuracy of jejunal atresia.

ObjectivesTo describe a new sonographic feature of the C‐sign for prenatal diagnosis of jejunal atresia and evaluate its role in prenatal jejunal atresia, particularly preceding bowel dilatation and polyhydramnios.MethodsThis was a retrospective study from a tertiary maternal hospital. Patients with prenatal sonographic examination and confirmed small bowel atresia postdelivery were included. All sonographic images were reviewed by two senior sonographers. Comparison of sonographic images between prenatal jejunal and ileal atresia using the C‐sign resembles the shape of the entire duodenum and other traditional sonographic features. The control group without bowel atresia was assessed for the presence of the C‐sign.ResultsThe C‐sign and combined bowel dilatation with polyhydramnios were more frequent in jejunal atresia than ileal atresia, but the C‐sign can be used to detect jejunal atresia earlier. The C‐sign can be more likely to diagnose jejunal atresia in persisting bowel dilatation and polyhydramnios. The C‐sign was not reported in any of the control fetuses.ConclusionThe C‐sign is a new sonographic feature that can be used to improve the prenatal accuracy and early detection of jejunal atresia. However, further prospective validation is needed.