First one with correct answer with justification win.

 

A one-day old, 36-week gestation infant is admitted to the neonatal intensive care unit (NICU) with bilious vomiting and abdominal distention. On exam, the infant is fussy but in no acute distress and the abdomen is soft but distended. Abdominal films suggest a proximal jejunal obstruction consistent with a jejunal atresia.

 

 

[size=20px]At laparotomy, a proximal jejunal atresia with significant dilation is found. Distally there is loss of small bowel consistent with an in utero volvulus and a string of sausage (i.e. type IV) segments of atretic small bowel with each of five segments of bowel measuring between three and eight cm in length. There is a three cm segment of terminal ileum and the entire colon. The next best step in management of this patient with complicated intestinal atresia is

 

A close the abdomen and return to the NICU.

 

B resect atretic small bowel segments and perform end jejunostomy.

 

C resect small bowel segments, taper jejunum and perform jejunoileostomy.

 

D jejunostomy/mucus fistula and thread atretic segments over a stent.

 

E resect all dilated proximal jejunum with primary anastamosis to atretic segments.[/size]

C

think again my dear

Ooops! I read jejunoileoanastomosis!🤦‍♀️

So what is the answer ?

D

D

correct

 

Multiple intestinal atresia is a rare form of small bowel atresia. The condition is often associated with absence of normal small bowel length ultimately resulting in short bowel syndrome and intestinal failure. At the time of the initial exploration, clearly nonviable bowel should be resected. However, every effort should be made to salvage all possible small bowel length including proximal dilated bowel and the distal atretic segments. The proximal bowel may be amenable to tapering or the serial transverse enteroplasty (STEP) procedure either initially or in the future. Multiple segmental anastomoses are an option.

 

An innovative alternative approach has been reported where the intestinal segments are threaded over a soft silastic catheter with a proximal mucus fistula and the distal end of the catheter brought out of the abdomen through the appendix. The segments then fuse or autoanastomose with time salvaging intestinal length. Intestinal continuity is established at a later operation.

There is a syndrome of hereditary multiple intestinal atresias which reveals multiple intestinal atresias from the stomach to the rectum in association with immune deficiency. These cases have been universally fatal.