History: Newborn with failure to pass meconium
Solution: Jejunal atresia
The radiographic findings in this case include a proximal obstruction with 3-4 loops of dilated bowel in the upper abdomen and no gas distally with a microcolon identified at the time of the barium enema. The differential diagnosis for a microcolon includes: Meconium ileus (not right for this case since although there is meconium, it is relatively scant and is not located in the TI), ileal/jejunal atresia (This case is better for jejunal atresia because of the number of bowel loops that are dilated proximally), Megacystitis-microcolon-hypoperistalsis syndrome (what?), colonic atresia (not here since we see the whole colon), and Hirschsprung disease (usually only involves the distal portions of the colon and rectum).
Most of these patients present on the first day of life with findings of bowel obstruction and failure to pass meconium. Most have \"normal\" intrauterine development. Can be associated with other processes like volvulus, gastroschisis, and malrotation. The findings in this case are typical. Needs surgery. This is the intra-operative image from this case showing the dilated proximal bowel and atretic more distal bowel.
Two meconium cysts from localized perforation were also seen in this case (inferior in image).
The radiographic findings in this case include a proximal obstruction with 3-4 loops of dilated bowel in the upper abdomen and no gas distally with a microcolon identified at the time of the barium enema. The differential diagnosis for a microcolon includes: Meconium ileus (not right for this case since although there is meconium, it is relatively scant and is not located in the TI), ileal/jejunal atresia (This case is better for jejunal atresia because of the number of bowel loops that are dilated proximally), Megacystitis-microcolon-hypoperistalsis syndrome (what?), colonic atresia (not here since we see the whole colon), and Hirschsprung disease (usually only involves the distal portions of the colon and rectum).
Most of these patients present on the first day of life with findings of bowel obstruction and failure to pass meconium. Most have \"normal\" intrauterine development. Can be associated with other processes like volvulus, gastroschisis, and malrotation. The findings in this case are typical. Needs surgery. This is the intra-operative image from this case showing the dilated proximal bowel and atretic more distal bowel.
Two meconium cysts from localized perforation were also seen in this case (inferior in image).
Radiograph Images
