Abstract

This case report focuses on a premature infant, who showed symptoms of bowel obstruction within the first hours of life, and was subsequently diagnosed with multiple small bowel atresia’s.

This infant was born to consanguineous parents by spontaneous preterm vaginal delivery at 33+3 weeks’ gestation, through a yellow-stained liquor thought to be meconium at the time of delivery, but later recognised as bile. The antenatal scans had been normal until one on the day prior to delivery, which showed polyhydramnios and a slightly distended bowel; further imaging and Obstetric review had been arranged for a diagnosis.

The infant was born in good condition and required no resuscitation. She was transferred to NICU for further management due to prematurity; there was no difficulty when inserting a nasogastric tube, but unusually 25 ml of bile stained fluid was aspirated immediately. Abdominal palpation was normal, but no bowel sounds were present. An abdominal x-ray showed huge proximal bowel obstruction with a classic ‘double-bubble’ appearance, with no bowel gas visible distal to this lesion. She was urgently transferred to a surgical centre, where she underwent diagnostic surgery and emergency repair of a type 1 and type 3b small bowel atresia, with an associated duodenal perforation.

With this case review we will discuss the different types, presentations and prognosis of bowel atresia’s within preterm infants, as well as looking at antenatal diagnosis and the difficulties faced with accurate diagnoses and subsequent management.