2006-01-09-09 Ileal atresia © Cuilllier www.thefetus.net/
Fabrice Cuillier, MD
Dept of Obstetrics and Gynecology, Hôpital Félix Guyon, Saint-Denis, Reunion Island, France
This is a 22 year-old woman, G2P1, with unremarkable obstetric history. The first examinations done at 13 and 22 weeks were normal. At 33 weeks, ultrasound revealed a moderate polyhydramnios and a enlarged bowel. The fetal growth was normal and no anomaly was detected. An amniocentesis was performed (46 XY). At 34 weeks, the same anomalies were confirmed. The delivery was performed at 37 weeks.
In neonatal unit, there was moderate abdominal distension. There was no respiratory distress. Anal and esophagus permeability were checked. A nasogastric tube was inserted and bilious discharge was obtained. Digestive aspiration was important (300 ml) the first day. A abdominal X-ray film at four hours postpartum located the obstruction. An ileal obstruction was suspected.
The patient was operated at day one. Ileal atresia was confirmed on the second and third loops. The proximal distended bowel was resected. An anastomosis was performed at 10 cm distal to the angle of Treitz. The bowel rotation was normal. The postoperative course was normal. But on day 16, 29 and 40, there were other bowel obstructions with digestive distension. At day 54, there was an important first loop bowel dilatation. Another resection and bowel anastomosis was performed in the same place, because the bowel cicatrization was filiform. After this second surgery, the baby did not have any problem and left the neonatal unit at day 75.