Multiple intestinal atresia (MIA) is a rare but critical neonatal condition marked by extensive bowel obstruction and challenging surgical care. A preterm female infant was diagnosed antenatally with suspected small bowel obstruction in the setting of polyhydramnios. After birth, she developed signs of intestinal obstruction. Abdominal radiography demonstrated proximal small bowel obstruction. Exploratory laparotomy revealed multiple type-I intestinal atresias, with a total of 20 intraluminal web-type atresias distributed throughout the small bowel. Careful intraoperative assessment was performed by systematic inspection and manual milking of intestinal contents distally to identify additional intraluminal obstructions. The markedly dilated proximal jejunum required tapering enteroplasty using a Gastrointestinal (GIA) linear stapler. Atretic areas were managed either by segmental resection with end-to-end anastomosis or excision of intraluminal webs via longitudinal enterotomy with transverse closure. A second laparotomy was required for correction of a residual mucosal web. Due to persistent obstruction, a third laparotomy was performed, where an additional missed ileal mucosal web was identified and excised. The infant remained in the Neonatal Intensive Care Unit (NICU) for nearly three months, receiving Total Parenteral Nutrition (TPN) and supportive therapy. She was discharged on full oral feeds and remained well at long-term follow-up, thriving at three years of age. In newborns with multiple intestinal atresias, all efforts must be made to prove bowel continuity before completing the initial operation, as intraluminal membranes are easily missed despite careful exploration.
Alkaabi et al. (Fri,) studied this question.