A Rare Case of Duodenal Atresia with Apple-peel Configuration of the Small Intestine and Malrotation

Introduction

According to the current understanding, errors in recanalization during the early gestation period lead to duodenal atresia. Duodenal atresia differs from intestinal atresias in other parts of the bowel, which are thought to result from vascular accidents during later phases of gestation [1] [2] [3]. We report a rare case of duodenal atresia with apple-peel configuration of the remaining small intestine, an absent superior mesenteric artery and associated malrotation in a preterm child, which indicates that in rare circumstances vascular accidents may be the underlying cause of duodenal atresia [4]. This is the 4^th such case to be reported in the English literature [4] [5] [6].

References

• 1 Sadler T. Digestive System. Langman's medical embryology.. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003: 285-319
• 2 Gross E, Armon Y, Abu-Dalu K. et al . Familial combined duodenal and jejunal atresia.  J Pediatr Surg. 1996;  31 1573
• 3 Lambrecht W, Kluth D. Hereditary multiple atresias of the gastrointestinal tract: Report of a case and review of the literature.  J Pediatr Surg. 1998;  33 794-797
• 4 Weber DM, Freeman NV. Duodenojejunal atresia with apple-peel configuration of the ileum and absent superior mesenteric artery: Observations on pathogenesis.  J Pediatr Surg. 1999;  34 1427-1429
• 5 Arbell D, Orkin B, Naveh Y. et al . Duodenojejunal atresia with absent dorsal mesentery, choledochal cyst, and malrotation in a premature newborn – a case report.  J Pediatr Surg. 2006;  41 (6) e11-e13
• 6 Ahmad A, Sarda D, Joshi P. et al . Duodenal atresia with ‘apple-peel configuration’ of the ileum and absent superior mesenteric artery: A rare presentation.  Afr J Paediatr Surg. 2009;  6 (2) 120-121
• 7 Fonkalsrud EW, De Lorimier AA, Hays DM. Congenital atresia and stenosis of the duodenum.  Pediatrics. 1969;  43 79-83
• 8 Santulli TV, Blanc WA. Congenital atresia of the intestine: Pathogenesis and treatment.  Ann Surg. 1961;  154 939-948
• 9 Lister J. Intestinal atresia and stenosis, excluding the duodenum.. In: Lister J, Irving I, Rickham PP , editors. Neonatal Surgery London, UK: Butterworth and Co; 1990: 453-473

Correspondence