Type-3B intestinal atresia in dizygotic twins: a case report

Jejunoileal atresia is a rare cause of neonatal intestinal obstruction. Apple peel atresia (type IIIb) represents less than 5% of jejunoileal atresia cases and is exceptionally uncommon in twins. We report premature dizygotic twins born to consanguineous parents, both with apple-peel atresia. Twin 1 (female, 2.3 kg, Apgars 4/6/8) developed bilious vomiting and failure to pass meconium. Abdominal radiograph showed a triple-bubble sign. Urgent laparotomy revealed apple-peel jejunal atresia with 10 cm nonviable ileum; resection, tapering enteroplasty, and primary end-to-end anastomosis were performed. Postoperatively uneventful, full oral feeding reached at 3 weeks, and discharged on day 25. Twin 2 (male, 2.1 kg, Apgars 5/8/9) developed bilious vomiting and failure to pass meconium. Abdominal radiograph demonstrated a single dilated loop with no distal gas. on arrival the abdomen was distended with periumbilical erythema. Emergency laparotomy revealed duodenal atresia with apple-peel configuration and entire small bowel gangrene; total resection, distal caecostomy, and duodenostomy tube were performed. Intestinal transplantation was not available and the infant died three weeks later due to sepsis. Although rare, type-3B intestinal atresia may develop in dizygotic twins and should be included in the differential diagnosis of twin pregnancies with polyhydramnios.