Delayed diagnosis of type I jejunal atresia in an infant with intractable vomiting: a case report

TL;DR

A 14-month-old infant with chronic vomiting was finally diagnosed with a rare type I jejunal atresia after being misdiagnosed multiple times.

Contribution

This case emphasizes the need to consider congenital structural anomalies in infants with unexplained gastrointestinal symptoms.

Findings

The infant had type I jejunal atresia caused by an incomplete mucosal diaphragm and fibrous bands.

Surgical resection and anastomosis led to full recovery and catch-up growth.

Persistent symptoms unresponsive to treatment may indicate rare congenital causes.

Abstract

We report the case of a 14-month-old infant with chronic vomiting and recurrent subocclusive episodes since 40 days of life. Initially misdiagnosed as cow’s milk protein allergy and gastritis, the infant underwent repeated admissions for dehydration and failure to thrive. Radiologic studies demonstrated dilated proximal small bowel loops but no obvious cause for obstruction. Exploratory laparotomy revealed a type I jejunal atresia due to an incomplete mucosal diaphragm and two congenital fibrous bands contributing to intermittent obstruction. Resection of the segment and division of the bands with end-to-end anastomosis resulted in full clinical recovery and catch-up growth. This case highlights the importance of considering congenital structural anomalies, such as partial atresias and congenital bands, in the differential diagnosis of persistent gastrointestinal symptoms in infants, especially when these symptoms are unresponsive to medical treatment and radiologic studies suspicious of partial obstruction.

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