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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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LETTER TO THE EDITOR
Year : 2018  |  Volume : 23  |  Issue : 3  |  Page : 174-175
 

Acquired ileal atresia in a 3-year-old patient: A rare case


Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Web Publication4-Jul-2018

Correspondence Address:
Dr. Aditya Pratap Singh
Near the Mali Hostel, Main Bali Road, Falna, Pali - 306 116, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_237_17

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How to cite this article:
Garg D, Singh AP, Gupta AK, Shukla AK. Acquired ileal atresia in a 3-year-old patient: A rare case. J Indian Assoc Pediatr Surg 2018;23:174-5

How to cite this URL:
Garg D, Singh AP, Gupta AK, Shukla AK. Acquired ileal atresia in a 3-year-old patient: A rare case. J Indian Assoc Pediatr Surg [serial online] 2018 [cited 2019 Nov 12];23:174-5. Available from: http://www.jiaps.com/text.asp?2018/23/3/174/235906




Sir,

Parent of a 3 year old male child presented to us with the complaints of vomiting and abdominal distension of last 3 days. He also had history of not passing stool for 2 days. There was no history of blood in stool or vomiting. Vomiting was bilious and nonprojectile. On examination, general condition of the patient was good and no pallor or cyanosis was there, the abdomen was tender and distended. No lump was palpable. On per rectal examination, rectum was empty. Vitals were normal. There was no history of previous surgery. Abdominal radiograph showed grossly dilated bowel loops and a paucity of rectal gas. Ultrasound also reported dilated bowel loops. Blood reports were normal. The patient was prepared for surgery in emergency theater.

At laparotomy, the following findings were present: there was dense adhesion in the abdomen in-between bowel loops. Adhesion was released, and the band was cut. On exploration, we found dilated proximal ileum and atretic distal ileum approximately one feet proximal to ileocecal junction. There was defect in the mesentery of the ileum present [Figure 1]. Dilated part of the ileum was resected. Patency of distal segment was tested by putting feeding tube and saline. End to back ileoileal anastomosis was done in single layer. Postoperative recovery was uneventful. The patient had started oral on 5th day and discharged after 8 day of surgery.
Figure 1: Photo showing Type 3 ileal atresia

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Intestinal atresia typically present in neonatal period with the classical symptoms of abdominal distension and vomiting.[1] A postnatally acquired ileal atresia is very rare. Only 10 cases are described in literature. Available reports imply that mechanical forces on the intestine (adhesive band, volvulus, and intussusception) dominate the pathogenesis of acquired ileal atresia.

A total of 10 cases of acquired ileal atresia were identified in literature. The patients' ages ranged from 3 weeks to 2 years. Our case is the first with age of >2 years. Most common affected site is distal ileum and the most frequent finding is Type 3A ileal atresia. Causes of acquired ileal atresia included adhesion band, intussusception, abdominal abscess, and an infant with a postvolvulus bowel anastomosis which resulted in a Type 3A ileal atresia 7 weeks following surgery.[2]

The origin of atresia was identified only in 5 cases. In two cases, intraoperative findings suggested to an intussusception and a volvulus as the initiating factors in the development of the acquired ileal atresia.[3] In one case, a septic thrombus may have resulted in Type 3A atresia.[4] Bing et al. described 3 cases of acquired ileal atresia induced by adhesive intestinal obstruction.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank Dr. Maryem Ansari, MD in Pathology, Assistant Professor, SMS Medical College, Jaipur, Rajasthan, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Grosfeld JL. Jejunal atresia and stenosis. In: Grosfeld JL, O'Neill JA Jr., Fonkalsrud EW, Coran AG, editors. Pediatric Surgery. 6th ed. Philadelphia: Mosby; 2006. p. 1269-87.  Back to cited text no. 1
    
2.
López Candel E, Castejón Casado J, Azcón Aguilar P, Martínez Martínez L, Jiménez Alvarez C. Acquired postnatal intestinal atresia. An Esp Pediatr 1993;38:61-2.  Back to cited text no. 2
    
3.
Elemen L, Tugay M, Erkuş B, Gürbüz Y. Acquired ileal atresia because of adhesive small bowel obstruction. J Pediatr Surg 2010;45:1383-4.  Back to cited text no. 3
    
4.
Drabløs PA, Hoel P, Vogt H, et al. Postnatal acquired intestinal atresia: A case report. Z Kinderchir 1979;26:227-30.  Back to cited text no. 4
    
5.
Bing L, Wei-Bing C, Shou-Qing W, Ye-Bo W. Acquired ileal atresia induced by adhesive intestinal obstruction. Indian J Pediatr 2014;81:507-8.Sir,  Back to cited text no. 5
    


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