Jejunal web as the cause of bowel obstruction in a toddler: Case report and brief literature review. (October 2021)

• Record Type: Journal Article
• Authors: Khoei, Samin; Borhani, Ali; Ghavamiadel, Maryam; Zamani, Fatemeh
• Is Part Of: International journal of surgery case reports. Volume 87(2021)
• Publication Date: 2021-10
• Subjects: Bowel obstruction -- Pediatric imaging -- Jejunal web -- CT-scan -- Case report -- Pediatric surgery; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106455
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Intestinal webs which are categorized under type-1 intestinal atresia rarely occur in the jejunum. These webs are occasionally diagnosed late because their central fenestration allows the passage of food. Case presentation: We report a toddler who presented with atypical symptoms of bowel obstruction and non-specific plain radiograph and ultrasound findings. The diagnosis of jejunal obstruction was made possible with contrast-enhanced computed tomography and obstruction was found to be the result of a jejunal web at the surgery. Clinical discussion: Few cases of jejunal webs are reported in the literature. The jejunum is the site of only 8% of webs and 33% of jejunal webs are associated with other congenital anomalies and/or prematurity. Conclusion: Jejunal web needs a high degree of suspicion to be diagnosed and should be kept in mind as a differential diagnosis in the setting of unexplained persistent non-bilious emesis in otherwise normal toddlers. Highlights: Jejunum is the site of 8% of webs and 33% of jejunal webs are associated with other congenital anomalies and/or prematurity. Jejunal webs may become only intermittently symptomatic because their central fenestration allows passage of food. Vascular, Re-canalization, disrupted endodermal development and hyper-proliferation theories are proposed as their etiology Intra-operative endoscopy for localizing and resection of jejunal webs is a new approach in the treatment of this entity.