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Diagnosing Ileal Atresia: The Role of Clinical Correlation and Plain Radiography

Timothy Mwai Jumbi1, Manvinder Singh Mann1, Joel Kipyegon Lessan2

1. University of Nairobi

2. Kenyatta National Hospital

Correspondence to: Dr. Timothy Jumbi, University of Nairobi P.O Box 1059- 00618 Nairobi, Kenya.

Email:mwaitim@gmail.com

Summary

Ileal atresia is a subset of congenital gastrointestinal malformations that result in neonatal bowel obstruction. We report a case of a 7-day old male neonate who presented with failure to pass meconium, abdominal distension and late onset bilious vomiting. A plain abdominal radiograph revealed dilated bowel loops with fluid levels of different sizes, the largest appearing as a fluid filled mass with an abrupt cut off. These findings were consistent with ileal atresia and the diagnosis was confirmed intra-operatively. This case description is aimed at emphasizing the role of clinical correlation and a plain abdominal radiograph in the diagnosis of ileal atresia which are two important modalities that have imaging modalities which delay management. The diagnosis of ileal atresia can be suspected in the neonate who presents with failure to pass meconium, abdominal distension,  late  onset  bilious  vomiting  and  a  plain abdominal  radiograph  with  fluid  levels  of  different sizes, the largest situated just proximal to the atretic zone.

Key words: Ileal atresia, plain radiograph, clinical assessment

Ann Afr Surg. 2018;15(2):73-76

DOI:http://dx.doi.org/10.4314/aas.v15i2.9

© 2018 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Conflicts of Interest: None

Funding: None

​Introduction

Small intestinal atresia is a congenital anomaly characterized by the abnormal closure, discontinuity or narrowing of the duodenum, jejunum or ileum. (1) The diagnosis  of Intestinal atresia is based on clinical correlation and a plain radiograph. The value of these two modalities has been blurred by the irrational use of ultrasound  and other  imaging modalities.  (2)More importantly the clinical signs and symptoms may provide a clue as to the site of intestinal atresia while the radiograph confirms the diagnosis. High intestinal atresia include duodenal and jejunal atresia while low intestinal  atresia includes  distal ileum and colonic atresia.  (3) We review the importance of a plain radiograph and clinical assessment in a neonate with ileal atresia with   an aim of emphasizing that unnecessary imaging investigations do not add value in a clear-cut diagnosis. Case Presentation A 7-day old male infant was referred to the newborn unit of Kenyatta National Hospital, Nairobi Kenya. The reason for referral was failure to pass meconium since birth requiring further investigation and management. The child also had progressive abdominal distension over the 6 days and associated vomiting that was initially non-bilious but progressed to become bilious on the 5th day of life. Details of any relevant pre-natal occurrences and events during delivery or immediately after birth are unclear as the infant was born at home and the mother did not attend any antenatal care clinic. On examination the neonate was stable, well hydrated with warm extremities. The abdominal examination revealed a grossly distended abdomen with visible bowel loops but otherwise non tender (figure 1).

Click to view figure 1

The bowel sounds wer