Jejunalatresie

Premature
newborn after umbilical venous catheter placementAXR AP shows the tip of the umbilical venous catheter curling back upon itself within the umbilical vein. The tip of the umbilical arterial catheter projects at T6. The proximal small bowel is massively dilated.The diagnosis was low malposition of the umbilical venous catheter and appropriate position of the umbilical arterial catheter in a patient with jejunal atresia.
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Newborn with
a distended abdomen and bilious aspiratesSurgical image shows dilation of the proximal jejunum with a blind end (to the left) and a distal apple-peel deformity with extensive atresias of the jejunum and ileum (to the right).The diagnosis was jejunal atresia.
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A rare type
of Jejunal atresia (Apple peel small bowel). Dilated air filled stomach and proximal bowel loops with no evidence of air in the distal loops, nasogastric tube is seen inside the stomach
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A rare type
of Jejunal atresia (Apple peel small bowel). Upper GI study demonstrated contrast material within the stomach and dilated duodenum and proximal jejunum with an abrupt cut off at the level of the proximal jejunum (arrow)
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A rare type
of Jejunal atresia (Apple peel small bowel). Lower GI study shows small caliber colons containing filling defects (meconium plugs)
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A rare type
of Jejunal atresia (Apple peel small bowel). Malrotated micro colon post meconium plugs evacuation
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Newborn with
vomiting. AXR supine (left) shows a dilated stomach in the left upper quadrant and a dilated duodenum in the right upper quadrant and a dilated loop of proximal jejunum inferiorly (triple bubble sign). There is no gas distally. AXR upright (right) shows air fluid levels in the stomach and duodenum and in the dilated loop of proximal jejunum.The diagnosis was jejunal atresia.
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Newborn with
a loopy abdomen. Surgical mage shows a dilated proximal jejunum (between the fingers) and a normal caliber distal jejunum (between the forceps).The diagnosis was jejunal atresia.
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Newborn with
a loopy abdomen: The diagnosis was jejunal atresia.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Jejunal atresia is a congenital anomaly characterized by obliteration of the lumen of the jejunum. The site of the atresia can be anywhere from the ligament of Treitz to the jejunoileal junction. There can be more than one atretic segment.

This article will focus on jejunal atresia alone but bear in mind that some cases correspond to jejunoileal atresia and show a mixed pattern, including the ones discussed in the ileal atresia article.

Epidemiology

Jejunal atresia has an incidence of about 1:1,000 live births and is more common than duodenal atresia.

Clinical presentation

Neonates typically present with abdominal distension and bilious vomiting within the first 24 hours of birth. These symptoms, however, do not allow for differentiation from a duodenal atresia.

Pathology

The etiology is thought to be from an in-utero ischemic event.

Radiographic features

Plain radiograph

The classic radiographic sign of jejunal atresia is that of a triple bubble appearance for a proximal obstruction; it is equivalent to the double bubble sign of duodenal appearance plus a third bubble is caused by filling and distention of the jejunum by air.

There can be multiple dilated small bowel loops proximal to the atresia and the number of dilated loops increase as point of atresia becomes more distal.

Fluoroscopy

Contrast enema typically shows micro colon (small unused colon)

Antenatal ultrasound

Differential diagnosis 

On plain radiograph consider:

On contrast enema consider:

See also 

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Jejunalatresie:
Duodenalatresie
 
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