When a Patient's Weight Exceeds Your Scale

This condition is characterized by a localized narrowing of the jejunum without a disruption of continuity or defect in the mesentery. At the stenotic site, there is often a short, narrow segment with a minute lumen where the muscularis is irregular and the submucosa is thickened. The resultant intestinal obstruction is incomplete.

Jejunal stenosis accounts for 5% of jejunoileal obstructions in children. The condition is slightly more common in the proximal jejunum (A). Jejunal stenosis is thought to be caused by a late intrauterine mesenteric vascular catastrophe, which produces aseptic necrosis; the necrotic bowel is resorbed.

Infants with jejunal stenosis present with bilious vomiting, abdominal distention, and failure to pass meconium on the first day of life. A history of maternal polyhydramnios is not uncommon. About 30% of affected infants have unconjugated hyperbilirubinemia. Dehydration and aspiration pneumonia may result from delayed diagnosis and treatment.

The abdominal radiograph usually shows a few dilated loops of bowel with air-fluid levels. The more distal the stenosis, the greater the number of dilated loops of bowel and air-fluid levels. An upper GI tract series may reveal the exact site of stenosis (B).

Preoperative measures include nasogastric suction and intravenous correction of fluid and electrolyte imbalance. Surgery involves laparotomy, resection of the stenotic segment, and an end-to-end anastomosis between the dilated proximal bowel and the collapsed distal bowel.