Apple Peel Jejunal Atresia Associated with Intestinal Malrotation and Meckel's Diverticulum

Authors

Keywords:

jejunal atresia, apple peel

Abstract

Introduction: Type IIIB intestinal atresia is due to obstruction of the superior mesenteric artery. The distal ileum coils around the ileocolic artery, which derives, from there, all its vascularization, acquiring an “apple peel” appearance with marked dilation of the intestine proximal to obstruction and collapse of the distal segments.

Objective: To present a case of apple peel jejunal atresia associated with intestinal malrotation and Meckel's diverticulum in a newborn.

Case report: We report a newborn who, a few hours after birth, began to have a globular abdomen and decreased air fluid sounds. A simple radiographic study of his abdomen, colon contrast by enema, and pathological stomach and duodenum were performed. Exploratory laparotomy revealed type IIIB intestinal atresia associated with intestinal malrotation and Meckel's diverticulum. Lateral duodenal-jejunal anastomosis was performed. Functional intestinal transit is not achieved and he dies at two months of age.

Conclusions: Jejunal atresia is considered a rare disease. It can be associated with other malformations. Radiological examinations are ideal to begin the study and exploratory laparotomy corroborates digestive malformation and other associated anomalies.

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Author Biographies

Yurisandra Jiménez González, Hospital Provincial Pediátrico Universitario José Luis Miranda. Villa Clara, Cuba.

Especialista De I grado en Imagenología

Leidelén Esquivel Sosa, Hospital Provincial Pediátrico Universitario José Luis Miranda. Villa Clara, Cuba.

Master

Especialista De I y II grado en Imagenología

Abel Armenteros García, Hospital Provincial Pediátrico Universitario José Luis Miranda. Villa Clara, Cuba.

Master

Especialista De I y II grado en Cirugía Pediátrica

References

1. Molino JA, López Fernández S, Oliver B, Boix H, Rocha O, López M, et al. Atresia duodenal con Apple peel asociada a hernia diafragmática congénita: un caso excepcional y revisión de la literatura. Cir Pediatric. 2022 [acceso 02/04/2023];35:31-5. Disponible en: https://secipe.org/coldata/upload/revista/2022_35-1ESP_31.pdf

2. Jalles F, Morgado M, Janeiro M, Gonçalves M. Staged surgical treatment of apple peel intestinal atresia. J Pediatric Surg Case Rep. 2019 [acceso 02/02/2023];49:1-3. DOI: 10.1016/j.epsc.2019.101293

3. Astudillo Villarreal M, Naveda Guerrero A, Olaya Bohorquez C, Arroyo Pizarro Y. Atresia yeyunal tipo III A. Reporte de un caso clínico. Canarias Pediatr. 2018. [acceso 06/01/2023];42(1). Disponible en: https://portal.scptfe.com/atresia-yeyunal-tipo-iii-a-reporte-de-un-caso-clinico/

4. Bin Arif T, Ahmed J, Malik F, Nasir S, Ali A. An Atypical Variant of Apple Peel Atresia: Reporting a Rare Case. Cureus. 2022 [acceso 02/02/2023];11(11):e6047. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886733/pdf/cureus-0011-00000006047.pdf

5. Weledji EP, Monono N, Nana T. Late presentation of incomplete jejunal atresia. J Pediatr Surg Case Rep. 2020 [acceso 02/02/2023];55;1-3. Disponible en: https://www.sciencedirect.com/science/article/pii/S2213576620300464

6. Muta Y, Odaka A, Inoue S, Beck Y. Apple-peel intestinal atresia treated by diamond-shaped anastomosis to adjust the anastomosis size. J Pediatr Surg Case Rep. 2022 [acceso 02/04/2023];81:102269. Disponible en: https://www.sciencedirect.com/science/article/pii/S2213576622000963

7. Dao DT, Demehri FR, Barnewolt CE, Buchmiller TL. A New Variant of Type III Jejunoileal Atresia. J Pediatr Surg [Internet]. 2019 [acceso 02/02/2023];54(6):1257–60. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S002234681930106X

8. Mazingi D, Gwatirisa T, Mbuwayesango BA, Zimunhu T, Chowe S, Munanzvi K, et al. Monozygotic twins with jejuno-ileal atresia. J PediatrSurg Case Rep. 2019 [acceso 02/04/2023];41:33-6. DOI: 10.1016/j.epsc.2018.12.003

9. Parkera OM, Kenwrightb D, Stringer MD. Heterotopic gastric mucosa associated with jejunal atresia. J PediatrSurg Case Rep. 2019 [acceso 02/04/2023]; 43:58-61. DOI: 10.1016/j.epsc.2019.02.013

10. De Carli C, Ojeda M, Veloce D, González M. T-tube enterostomy for the management of complicated high jejunal atresia. An innovative procedure for complex intestinal entity. A technical report. J Pediatr Surg Case Rep. 2016 [acceso 02/04/2023];7:39-42. DOI: 10.1016/j.epsc.2016.02.016

11. Comunidad de Madrid. El Hospital público La Paz de la Comunidad de Madrid realiza el primer trasplante de intestino del mundo tras donación en asistolia. Madrid: Comunidad de Madrid; 2022 [acceso 18/04/2023]. Disponible en: https://www.comunidad.madrid/noticias/2022/10/11/hospital-publico-paz-comunidad-madrid-realiza-primer-trasplante-intestino-mundo-donacion-asistolia

Published

2024-03-19

How to Cite

1.
Jiménez González Y, Esquivel Sosa L, Armenteros García A. Apple Peel Jejunal Atresia Associated with Intestinal Malrotation and Meckel’s Diverticulum. Rev Cubana Pediatría [Internet]. 2024 Mar. 19 [cited 2025 Jul. 1];96. Available from: https://revpediatria.sld.cu/index.php/ped/article/view/4484

Issue

Section

NEONATOLOGÍA