One-Step Management of Apple-Peel Atresia

Abstract

Nowadays, the prognosis of apple-peel atresia depends mainly on prolonged TPN-related morbidity rather than immediate postoperative complications. We therefore recommend that those infants affected be managed by primary anastomosis in order to reduce the duration of parenteral nutrition, followed by careful nutrition by teams experienced in neonatal TPN and short bowel syndrome.

Apple‐peel jejunal atresia associated with multiple ileal atresias in a preterm newborn: A rare congenital anomaly

“…The apple-peel type of jejunal atresia (=type IIIb, Christmas tree intestinal atresia or maypole deformity), is a rare form of small bowel atresia with an incidence of approximately 1/50 000 live births. 1 This anomaly was initially described by Santulli and Blanc in 1961. 2 It is characterised by a proximal jejunal atresia near the ligament of Treitz, apple-peel (helical) configuration of the remaining small bowel and a complete absence of the dorsal…”

Bowel plication in neonatal high jejunal atresia

“…The survival rate in the past for those diagnosed with jejunal atresia was approximately 75%, but in recent years, with the improvement of prenatal screening, operation methods, and the progress of neonatal intensive care, the survival rate has been significantly improved. [3] Surgery is currently the only way to treat the disease, though operation methods are diverse. [4–6] Each method has its advantages and disadvantages, but the traditional end-to-end anastomosis (also known as the end to back anastomosis) is still the preferred operative method.…”

Apple Peel Jejunal Atresia in a Neonate: A Rare Cause of Intestinal Obstruction

“…Rather it leads to increased incidence of complications & longer hospital stay and needed total parenteral nutrition (TPN) in all cases as compared to primary anastomosis 6,7 . The mortality of apple peel atresia remains high though it has come down greatly in most of the reported series in the last two decades 5,7,8,9 . The improved survival in this malformation is due to early diagnosis by antenatal ultrasonography,appropriate surgery, better neonatal intensive care facility with multidisciplinary involvement and nutritional support.…”

“…Children with apple peel atresia suffer serious morbidity like short bowel syndrome , sepsis and TPN related complications during the post-operative course .Late morbidity is said to be low. They have a good chance of having normal bowel function with normal growth and development 8,10 . In summary apple peel deformity is a rare type of jejuno-ileal atresia, appropriate surgery and supportive care improves the outcome.…”