mately 2 to 3 in 10,000 births.2Jejunoileal atresia usu-
ally occurs more frequently than duodenal atresia. Mul-
tiple atresias are found in 7 to 20% of cases.1,3A few
cases of intestinal atresia with detailed descriptions of
prenatal sonographic findings have been reported.4-9
We present a case of isolated ileal atresia suggested by
results of prenatal sonography and confirmed by
postnatal radiographs with successful surgery. We also
discuss the clinical significance by reviewing recent re-
ports in the literature.
tresias are the most common congenital anoma-
lies of the midgut.1The incidence is approxi-
A23-year-old primigravida at 36 4/7 weeks of ges-
tation was referred with suggestion of fetal anomalies.
Prenatal sonography (Acuson, Aspen, CA, USA) re-
vealed a relatively enlarged fetal abdomen caused by
multiple markedly dilated fluid-filled loops with active
peristaltic movements (Fig. 1). The maximal diameter
obvious signs of dilated rectum or colon were identified.
Distal small intestine obstruction was suggested. No
other anomalies were found, including polyhydramnios,
organs (heart, kidney, liver, head and bones). Color
Doppler showed normal umbilical artery and ductus
venosus flow. After counseling, a 2964-g male infant
was delivered by cesarean section due to malpresentation
2 days after sonography. Apgar scores were 7 and 8 at 1
and 5 minutes, respectively. The chromosomal study
showed 46, XY. Abdominal distension was noted and
greenish bile-like materials were sucked fromthe stom-
ach. Oral contrast radiographs demonstrated distended
bowels, which suggested obstruction at the ileal level
(Fig. 2). Exploratory laparotomy on the third day
postpartum revealed an isolated ileal atresia, about 45
cm proximal to the ileocecal valve (Fig. 3). After cut-
ting 2 blind ends (about 20 cm in length) and tapering
the proximal dilated ileum, end-to-end primary anasto-
mosis was performed. Meconium and contrast medium
were passed on the second post-operative day. The in-
J Chin Med Assoc
1Department of Obstetrics and
Gynecology, Department of Radiology,
2Division of Pediatric Surgery, Veterans
General Hospital-Kaohsiung, Kaohsiung,
isolated ileal atresia;
Prenatal Sonographic Findings in a Fetus
with Congenital Isolated Ileal Atresia
Most cases of isolated nonduodenal bowel atresia are thought to be due to ischemic
events from hypotension, vascular accident, volvulus, intussusception and cocaine.
We present a case of isolated ileal atresia suggested using results of prenatal
sonography which showed multiple markedly dilated fluid-filled intestinal loops
with changeable shapes and positions secondary to active peristalsis. Postnatal oral
contrast radiography demonstrated obstruction located at the ileal level. Exploratory
laparotomy confirmed isolated ileal atresia. Primary end-to-end anastomosis was
ways havefatal prognosis, evenafter surgery. Casesof isolatedintestinalatresiausu-
ally have better prognosis and deserve more attention. Early diagnosis and early in-
tervention are both important for good outcomes.
Received: August 18, 2003.
Accepted: December 18, 2003.
Correspondence to: Fu-Nan Cho, MD, Department of Obstetrics and Gynecology, Veterans General
Hospital-Kaohsiung, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
Fax: +886-7-346-0284; E-mail: email@example.com