Duodenal Atresia with Apple-peel Intestinal Atresia: a Case with Favorable Outcome

Abstract

Objective − Duodenal atresia with apple-peel intestinal atresia remains a difficult and complex condition, even with advances in medical and surgical therapies. Due to the significant difference in etiology, the association between these two types of atresia is very rare and is associated with a high rate of mortality. Only twelve of these cases have been described so far in English literature, most often with a poor outcome. Our patient survived and is doing well.

Case Report − Here, we present a premature infant in whom intestinal atresia was suspected prenatally. On the first day of life, based on clinical, radiographic and ultrasound examination, suspicion was confirmed and surgical intervention was performed. It was discovered that the proximal part of the duodenum blindly ends with a large dilation. The proximal jejunum also ends blindly and the distal small intestine wraps around a single mesenteric vessel in a spiral fashion reminiscent of an “apple-peel.” At the first operation (on the first day of life), a double enterostomy of the proximal duodenum and the proximal jejunum was performed. On the second operation (on day 10), the continuity of the digestive intestine was established by end-to-end duodeno-jejunal anastomosis. Progress in body mass was confirmed during the postoperative period and normal stool was formed on a regular basis.

Conclusion − Based on our case, possible reasons for the good outcome of patients with these rare forms of intestinal atresia are prenatal suspicion, early postnatal diagnosis, and early surgical intervention. Further studies should investigate the possibility of a common cause of duodenal atresia and apple-peel atresia to facilitate early diagnosis and early treatment.