Clinica y Maternidad Suizo-Argentina, Swiss Medical Group, Buenos Aires- Argentina

Case
Healthy G2P1 mother, no remarkable history. The fetal ultrasound at 16 weeks was normal. A repeat examination at 34 weeks demonstrated moderate polyhydramnios and distended bowel in fetal abdomen. The diagnosis of fetal intestinal obstruction was entertained, possibly due to an imperforate anus.

At term: normal vaginal delivery, 3.400 female baby, Apgar 10/10. Moderate abdominal distention, normal anus, no colonic meconium (photo#2, arrow : visible distended bowel), no other anomalies A nasogastric tube was inserted and bilious discharge obtained.

A plain abdominal X-ray at 3 hours postpartum (photo#3), was not conclusive to locate the obstruction, if present. This x-ray was to "early" but bilious 
material obliged us to rule out intestinal obstruction. 

We decided to perform another X-ray the following morning injecting 60cc of air through the  nasogastric tube. A jejunal atresia was firmly suspected 
through this image. simultaneous barium enema showed a disused microcolon ( photo#4).

Surgery was performed at 24 hours postpartum. Atresia of jejunum was confirmed 40 cm distal to the angle of Treitz (photo#5). 

Intraoperative air injection showed that the distal jejunum, ileum and colon were patent without atresias. Normal bowel rotation. 
The proximal distended bowel was resected. In order to perform a proportionate anastomosis the proximal end was tailored, resecting an 
antimesenteric triangle. An anastomosis was performed ( photo#6). Uneventful recovery, soft abdomen. Breast feeding was started the 5° postop 
day.