Diagnostic Approach and Management of Jejunal Atresia

Initial Evaluation and Diagnostic Approach

For a newborn presenting with bilious vomiting, abdominal distension, and failure to pass meconium, plain abdominal radiographs are the first step to identify the pattern of bowel obstruction, followed by contrast enema if distal obstruction is suspected, and proceed to surgical correction with bowel resection and anastomosis once the diagnosis is confirmed, as recommended by the American College of Radiology 1, 2
Plain abdominal radiographs are the first-line imaging study for all suspected bowel obstruction, demonstrating dilated bowel loops, air-fluid levels, and the presence or absence of distal gas, according to the American College of Radiology 3
The presence of multiple dilated loops with variable amounts of distal gas distinguishes jejunal atresia from more proximal obstructions like duodenal atresia, which shows the classic "double bubble" sign, as stated by the American College of Radiology 1, 4

If radiographs show few distended bowel loops or a nonclassic pattern, an upper GI series is the reference standard to rule out malrotation with midgut volvulus, which is a surgical emergency requiring urgent intervention, as recommended by the American College of Radiology 1, 3
The UGI series identifies abnormal position of the duodenojejunal junction (ligament of Treitz) with 96% sensitivity for malrotation, according to the American College of Radiology 1
Malrotation with incomplete obstruction may have a normal bowel gas pattern, so maintain high suspicion in bilious vomiting within the first 2 days of life, as stated by the American College of Radiology 1

If radiographs suggest distal obstruction, contrast enema is the diagnostic procedure of choice, as it differentiates between meconium plug, ileal atresia, meconium ileus, and Hirschsprung disease, according to the American College of Radiology 2, 3
Contrast enema may show microcolon (due to lack of contents moving through the bowel) and helps identify the transition zone, as stated by the American College of Radiology 2, 3

Jejunal atresia results from intrauterine mesenteric vascular accidents, not failure of recanalization like duodenal atresia, as stated by the American College of Radiology 4
Jejunal atresia presents with multiple dilated loops rather than the isolated "double bubble" sign of duodenal atresia, according to the American College of Radiology 4, 3
The most critical diagnosis to exclude is midgut volvulus, which requires urgent surgery and can present with similar symptoms, as recommended by the American College of Radiology 1, 3
Bilious vomiting in a neonate is a surgical emergency until proven otherwise, as stated by the American College of Radiology 1