Open Jo urnal of Obstetr ics and Gynecology, 2011, 1, 121-123 OJOG
doi:10.4236 /ojog.2011.13021 Published Online September 2011 (
Published Online September 2011 in SciRes.
Intrauterine diagnosis of proximal jejunal atresia in a neonate
conceived by assisted conception technique: a case report
Adebiyi Gbadebo Adesiyun1*, Modupeola Omotara Samaila2, Ayodele Cole Benson3
1Department of Obstetr ics & Gynaecology, Ahmadu Bel lo University Teaching Hospital, Zaria, Nigeria;
2Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria;
3Echo -Scan Services Limited, Kaduna, Nigeria.
E-mai l : H
Received 4 July 2011; revised 4 August 2011; accepted 1 1 Aug ust 201 1.
Jejunal atresia is an entity within an array of con-
genital intestinal anomalies. We present a case of an-
tepartum diagnosis of proximal jejunal atresia in a
baby conceived through assisted conception.
Keywords: Antepartum Diagnosis; Jejunal Atresia;
Ultrasound Scan; Assisted Conc eption
Jejunal atresia is a congenital intestinal anomaly seen in
neonates [1]. The common clinical presentation is intes-
tinal obstruction, usually within few days of birth [2].
There are conflicting reports on the association of assi-
sted conception and birth defects, however some authors
[3] have reported positive correlation with some birth
defects like neural tube defects, atresias and heart defects
Although, other authors have argued that maternal cha-
racteristic like age, factors responsible for infertility and
concurrent diseases may have influenced the increase in
birth defects and not the treatment itself [3]. This is a
case report of fetal jejunal atresia diagnosed by antepar-
tum sonographic evaluation at a gestational age of twenty
six weeks. Fetal jejunal atresia, though a rare entity, its
diagnosis in utero is yet to be reported from any resource
constrained setting like ours.
A thirty one year old primigravid woma n presented with
six mo nths his tory of a me norrhea a nd two wee ks hist ory
of abdominal discomfort. There was no associated his-
tory of bleeding per vaginum, drainage of liquor or uri-
nary symptoms. She conceived through invitrofertiliza-
tion and intracytoplasmic sperm injection as a result of
severe oligoastheno sper mia. Ph ysical e xamination sho wed
a heal thy looki ng woma n that was not p ale or j aundiced.
Her temperature was 37°, pulse rate was 76/min
and her blood pressure was 100/70 mmHg. Abdominal
examination showed a fundal height consistent with
thirty two weeks gesta tion. The fetal lie and presentation
could not be defined. A diagnosis of large for gestational
age uterus was made, to rule out multiple gestation and
hydramnios. Investigations done included a full blood
count, urea and electrolyte, urinalysis and sugar profile;
these were normal. An obstetric ultrasound showed a live
singleton fetus at a gestational age of twenty five weeks
and four days, moderate polyhydramnious and “triple
bubble” sign in the fetal abdomen (Figure 1). An ultra-
sonic diagnosis of fetal jej unal atresia was made.
Patient was subsequently booked for antenatal care;
she was placed on haematinics (daily oral ferrous su lp h ate,
folic acid) and prophylactic antimalaria (three tablets of
sulfadoxine/pyrimethamine combination). Both patient
and spouse were informed and counseled on the possible
implicatio n of the sonographic finding. She therea fter d e-
faulted from antenatal clinic attendance at thirty two
weeks gest at i on.
Patient later p resented with histor y of spo ntaneous va-
Figure 1. SONOGRAPHIC TRIPLE BUBBLE, sign in the
fetal abdomen.
A. G. Ad e s i yu n et al. / Open Journal of Obstetrics and Gynecology 1 (2 011) 121-123
Copyright © 2011 SciRes. OJOG
ginal deli ver y at a private hos p ital, three d a ys be fore p re-
sentat ion. S he had an une vent ful delive ry of a te rm male
neonate, who had been vomiting, with associated abdo-
minal distention and difficulty in breathing. The baby
was yet to pass meconium. Examination of the baby re-
vealed a body weight of 2.4 kg, with moderate pallor,
dehydration and pyrexia of 38°. The respiratory rate was
140/min with crepitations over the lung field. There was
moderate abdominal distension. A diagnosis of neonatal
intestinal obstruction and aspiration pneumonitis was
made. The baby was optimized for surgery .The intra
operative findings were consistent with intestinal ob-
struction secondary to proximal jejunal atresia. This was
confirmed by histopathologic assessment of the speci-
men that sho wed distor tio n of the architecture of the wall
by fibromuscular tissue extending into the submucosa
and mucosa, and creating a trapped mucosa, papillae and
bridging fibro sis ( Figure 2).
In this report, intrauterine diagnosis of fetal jejunal atre-
sia was based on ultrasonogra phic “triple b ubble” sign in
the fetal abdomen [4,5]. This sign is fairly speci- fic for
jejunal atresia [5]. Aetiologicall y, jejunal atresia develops
as a result of intrauterine ischaemic event or vascular
accident leading to absorption of necrotic sterile bowel
[6]. Parvovirus B19 infection has also been impli- cated
in its causation [7]. The prevalence of jejunal atresia is
about 1 per 3000 live births [8]. Though the patient was a
male c hild, ther e is no sex p red ilectio n in t he pat hoge ne-
sis of this anomaly [9]. Its occurrence is higher in mo-
nozygotic twins compared to singleton and dizygotic
twins [10]. Jejunal atresia can occur as part of complex
congenital anomalies in 10% to 30% of cases [6]. Cystic
fibrosis, renal dysplasia and atresia of the biliary tract
could be associated with it.
The classic presentation of bilous vomiting and ab-
dominal distension was observed in this neonate. Mater-
nal polyhydramious which was present in this case, is
said to occur in about 9% of cases with intestinal atresia
and stenosis [2]. Passage of meconium before presenta-
tion is not an uncommon finding [2], though the baby
being reported had not passed meconium at presentation
to the emergency. The importance of “triple bubble: sign
on erect abdominal radiograph of neonates with jejunal
atresia should not be neglected, especially in a resource
constrained se ttings like ours [11].
The treatment of proximal jejuna atresia is mainly sur-
gical. However, the availability of parenteral nutrition,
neonatal intensive care unit and improved pediatric an-
esthe sia c ould imp ro ve t he sur viva l of t hese pat ient s [ 12] .
In this case report, should the ultrasonographic “triple
bubble” sign which is fairly specific for jejunal atresia,
Figure 2. Microscop ic appearance of pro ximal
jejuna atresia.
was accorded due r eco gnitio n a nd at tent ion b y the ph ysi -
cians and patients, it would have aided in close observa-
tion and early intervention after birth, thus preventing
vascular complications like gangrene and perforation
which the baby was fortunate not to have. Furthermore,
lack of weighted emphasis on the sonographic finding
during counseling may have been the reason why the
patient defected to a private health facility to deliver and
not to have informed the health personnel’s of the earlier
ultrasound finding.
The overall survival of about 90% was recorded in
developed countries following management of proximal
jejuna atresia [12] as against 50% to 60% reported from
developing countries [2,13]. However, against all odds
this baby survived .
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