Jejunal Stenosis: A Capsule Review

This condition is characterized bya localized narrowing of the jejunumwithout a disruption of continuityor defect in the mesentery. At thestenotic site, there is often a short,narrow segment with a minute lumenwhere the muscularis is irregularand the submucosa is thickened.The resultant intestinal obstructionis incomplete.Jejunal stenosis accounts for 5%of jejunoileal obstructions in children.The condition is slightly more commonin the proximal jejunum (A). Jejunalstenosis is thought to be caused bya late intrauterine mesenteric vascular catastrophe, whichproduces aseptic necrosis; the necrotic bowel is resorbed.Infants with jejunal stenosis present with biliousvomiting, abdominal distention, and failure to pass meconiumon the first day of life. A history of maternal polyhydramniosis not uncommon. About 30% of affected infantshave unconjugated hyperbilirubinemia. Dehydrationand aspiration pneumonia may result from delayeddiagnosis and treatment.The abdominal radiograph usually shows a few dilatedloops of bowel with air-fluid levels. The more distal thestenosis, the greater the number of dilated loops of boweland air-fluid levels. An upper GI tract series may revealthe exact site of stenosis (B).Preoperative measures include nasogastric suctionand intravenous correction of fluid and electrolyte imbalance.Surgery involves laparotomy, resection of thestenotic segment, and an end-to-end anastomosis betweenthe dilated proximal bowel and the collapsed distalbowel.