International journal of surgery case reports · 2026
Duodenal atresia associated with apple-peel configuration of distal small bowel in a late preterm neonate: a rare case report and literature review.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Kebede Minale Menberu, Mihretie Jejaw Endale, Wassie Mesfin Tesera, Amare Asratu Getnet, Abebe Temesgen Agegnehu
Аннотация
INTRODUCTION: The association of duodenal atresia with apple-peel (Christmas tree) configuration of the distal small bowel is exceptionally rare, with only a few cases reported in the literature. This unusual combination is of particular interest because it may provide evidence supporting a vascular etiology for selected cases of duodenal atresia. We report a neonate with type III duodenal atresia associated with apple-peel bowel and absent proximal superior mesenteric artery anatomy.
CASE PRESENTATION: A late-preterm (35 + 5 weeks) female neonate with antenatal suspicion of jejunal atresia presented on the second day of life with bilious vomiting and mild abdominal distension. Plain abdominal radiography demonstrated a double-bubble sign suggestive of duodenal obstruction. Exploratory laparotomy revealed type III duodenal atresia immediately distal to the ampulla of Vater. The third and fourth portions of the duodenum, the ligament of Treitz, and the proximal superior mesenteric artery were absent. The distal small bowel exhibited an apple-peel configuration, with a long segment of jejunum and ileum spiraling around a single vascular pedicle in the absence of normal mesentery.
DIAGNOSIS THERAPEUTIC INTERVENTION AND OUTCOMES: A diagnosis of duodenal atresia associated with apple-peel small bowel was established intraoperatively. Duodenojejunostomy was performed with preservation of maximal bowel length. The postoperative course was uneventful, with successful establishment of enteral feeding and discharge in stable condition.
CONCLUSION: This rare association supports an intrauterine vascular etiology for both duodenal atresia and apple-peel bowel. Awareness of this variant is essential for careful surgical planning and bowel preservation, while trans-anastomotic feeding offers a crucial alternative for early enteral nutrition in total parenteral nutrition-limited settings.
CASE PRESENTATION: A late-preterm (35 + 5 weeks) female neonate with antenatal suspicion of jejunal atresia presented on the second day of life with bilious vomiting and mild abdominal distension. Plain abdominal radiography demonstrated a double-bubble sign suggestive of duodenal obstruction. Exploratory laparotomy revealed type III duodenal atresia immediately distal to the ampulla of Vater. The third and fourth portions of the duodenum, the ligament of Treitz, and the proximal superior mesenteric artery were absent. The distal small bowel exhibited an apple-peel configuration, with a long segment of jejunum and ileum spiraling around a single vascular pedicle in the absence of normal mesentery.
DIAGNOSIS THERAPEUTIC INTERVENTION AND OUTCOMES: A diagnosis of duodenal atresia associated with apple-peel small bowel was established intraoperatively. Duodenojejunostomy was performed with preservation of maximal bowel length. The postoperative course was uneventful, with successful establishment of enteral feeding and discharge in stable condition.
CONCLUSION: This rare association supports an intrauterine vascular etiology for both duodenal atresia and apple-peel bowel. Awareness of this variant is essential for careful surgical planning and bowel preservation, while trans-anastomotic feeding offers a crucial alternative for early enteral nutrition in total parenteral nutrition-limited settings.