A 20 year old primigravida underwent a routine ultrasound scan at 28 weeks gestation. The scan showed dilated loops of intestine suggestive of intestinal obstruction. A follow up scan at 32 weeks gestation confirmed the findings. At term, a baby girl weighing 2.3 kg was delivered. Abdominal distension was present at birth and gastric aspirate was bile stained. Postnatal ultrasound and X-ray abdomen showed dilated fluid filled bowel loops suggestive of small intestinal obstruction.

Exploratory laparatomy revealed a proximal jejunal atresia 6 cm segment along with curved sausage like loop of intestine 2.5 cm in length i.e., intussusception of the jejunum 25 to 30 cm distal to the duodeno-jejunal junction (Type 1 atresia). The intussusceptum and atretic segment were resected and an end-to-end anastomosis was done. The patient showed good improvement after surgery and was started on gavage feeding on day 5 which was tolerated well and postoperative period was uneventful.

Gross examination of the respected specimen did not reveal any gangrene. Microscopic examination confirmed intussusception. The proximal atretic jejunum had a blind end.

Intussusception is rare in the neonatal period. Of about 6000 published cases in the pediatric population, only 28 occurred in the neonatal period [3]. The commonest site was the ileum. The jejunum is an uncommon location. The cause of the intussusception is unknown in majority of the cases. A case of ileal atresia consequent to intrauterine intusussception has been reported before in Indian literature [4]. Intrauterine intussusceptions causing jejunal atresia is further rare with only few cases described in the literature [2, 5].

It has been suspected that intestinal atresia may be secondary to prolonged bowel ischemia in utero [6], thus a careful examination of distal blind end is important in making the diagnosis.

Contributors: SD and RB collected patients’ records, drafted the manuscript and performed the review of the literature. AN was involved in patient management and reviewed the manuscript. All authors approved the final manuscript.

Funding: None; Competing interests: None stated.

1. Sweeney B, Surana R, Puri P. Jejunoileal atresia and associated malformations: correlation with the timing of in utero insult. J Pediatr Surg. 2001;36:774-6.

2. Saxena AK, Van Tuil CV. Intrauterine intussusception in the etiology of jejunal atresia. Dig Surg. 2008; 25:187.

3. Price KJ, Roberton NR, Pearse RG. Intussusception in preterm infants. Arch Dis Child. 1993;68:41-2.

4. Rattan KN, Singh Y, Sharma A, Pandit SK, Malik V. Intrauterine intusussception – a cause for ileal atresia.Indian J Pediatr. 2000;67:851-2.

5. Reed DN Jr, Polley TZ Jr, Rees MA. Jejunal atresia secondary to intrauterine intussusception, presenting as acute perforation. Can J Surg. 1987;30:203-4.