Jejunal Atresia

Etiology: In utero vascular accident so it has no other associated congenital abnormalities
Imaging AXR: Triple bubble sign of dilated stomach, duodenal bulb or duodenum, and proximal jejunum
Imaging UpperGI: Dilation of the duodenum and extreme dilation of the proximal jejunum and no distal passage of contrast on delayed images
DDX:
Complications: Multiple gastrointestinal atresias can exist in the same patient so it is important for surgeon to run the entire bowel during repair
Treatment: Surgical
Clinical:
— May see multiple atresias spiraling around the ileocolic artery (apple-peel atresia)
— 10% have cystic fibrosis

Radiology Cases of Jejunal Atresia

AXR of jejunal atresia — AXR AP shows extreme dilation of the stomach to the left of the spine, the duodenum to the right of the spine and a loop of proximal jejunum inferior to the stomach and to the left of the spine – a triple bubble sign.

AXR of umbilical venous catheter misplacement in umbilical vein — AXR 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.

AXR of jejunal atresia — 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.

UGI of jejunal atresia — AP image from an upper GI exam shows dilation of the duodenum and extreme dilation of the proximal jejunum. There was no distal passage of contrast on delayed images.

AXR and enema of jejunal atresia

Surgery Cases of Jejunal Atresia

Surgical image of jejunal atresia — Surgical 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).

Surgical image of jejunal atresia — Surgical image shows a dilated stomach and duodenum (above) due to an atresia in the proximal jejunum. The remainder of the jejunum is spiraled around the ileocolic artery (apple peel atresia).

Surgical image of jejunal atresia — Surgical image obtained after resection and anastomosis of an atresia in the proximal jejunum (upper left) shows the jejunum spiraled around the ileocolic artery (apple peel atresia).

Surgical image of jejunal atresia — Surgical mage shows a dilated proximal jejunum (between the fingers) and a normal caliber distal jejunum (between the forceps).