This condition is characterized by
a localized narrowing of the jejunum
without a disruption of continuity
or defect in the mesentery. At the
stenotic site, there is often a short,
narrow segment with a minute lumen
where the muscularis is irregular
and the submucosa is thickened.
The resultant intestinal obstruction
Jejunal stenosis accounts for 5%
of jejunoileal obstructions in children.
The condition is slightly more common
in the proximal jejunum (A). Jejunal
stenosis is thought to be caused by
a late intrauterine mesenteric vascular catastrophe, which
produces aseptic necrosis; the necrotic bowel is resorbed.
Infants with jejunal stenosis present with bilious
vomiting, abdominal distention, and failure to pass meconium
on the first day of life. A history of maternal polyhydramnios
is not uncommon. About 30% of affected infants
have unconjugated hyperbilirubinemia. Dehydration
and aspiration pneumonia may result from delayed
diagnosis and treatment.
The abdominal radiograph usually shows a few dilated
loops of bowel with air-fluid levels. The more distal the
stenosis, the greater the number of dilated loops of bowel
and air-fluid levels. An upper GI tract series may reveal
the exact site of stenosis (B).
Preoperative measures include nasogastric suction
and intravenous correction of fluid and electrolyte imbalance.
Surgery involves laparotomy, resection of the
stenotic segment, and an end-to-end anastomosis between
the dilated proximal bowel and the collapsed distal