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
Photo showing Type 3 ileal atresiaIntestinal 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]
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Figure 1