What is the primary treatment for a patient with jejunal atresia type II?

Primary Treatment for Jejunal Atresia Type II

The primary treatment for jejunal atresia type II is surgical resection of the atretic segment with the dilated proximal bowel, followed by end-to-end anastomosis to restore intestinal continuity. 1, 2

Surgical Approach

Definitive Surgical Management

• Resection and primary anastomosis is the standard of care for type II jejunal atresia (interrupted atresia with fibrous cord connection between bowel ends) 2
• The dilated proximal bowel segment should be resected along with the atretic portion to prevent ongoing dysmotility and facilitate functional recovery 2
• End-to-end single-layer anastomosis using either Halsted horizontal mattress or conventional interrupted sutures is the preferred technique 2

Surgical Access

• A circumumbilical incision provides adequate access for jejunal atresia repair with superior cosmetic outcomes compared to traditional transverse laparotomy 3
• This minimal access approach is feasible in the vast majority of cases and allows for revision through the same incision if needed 3

Key Surgical Principles

Bowel Preservation Strategy

• Minimize bowel resection to preserve intestinal length and prevent short bowel syndrome 2
• Only resect the clearly atretic segment and the immediately adjacent dilated bowel that would impair function 2
• This conservative approach to bowel length preservation is critical for avoiding long-term nutritional complications 1, 2

Intraoperative Considerations

• Carefully inspect the entire small bowel for additional atresias, as synchronous lesions can be missed initially 4
• If severe intestinal dilatation is present that would compromise anastomotic function, consider tapering procedures at the time of primary repair 1

Postoperative Management

Expected Recovery Timeline

• Oral feeding typically begins around day 5-6 postoperatively 2
• Full enteral caloric intake is usually achieved by day 12-13 2
• Some patients may require total parenteral nutrition (TPN) for approximately 1 month, though duration varies 4, 2

Monitoring for Complications

• Serial clinical examinations every 3-6 hours in the immediate postoperative period to detect anastomotic leakage or ongoing peritonitis 5
• Anastomotic complications (leakage or stricture) occur in a minority of cases and require immediate re-exploration if leakage is evident 5, 4
• Adhesive bowel obstruction may occur in the first year of life, requiring reoperation in approximately 14% of cases 1

Prognostic Factors

Favorable Outcomes

• Type II atresia has excellent prognosis with appropriate surgical management 1, 2
• Survival rates exceed 90% when isolated type II atresia is present without associated anomalies 1
• Long-term short bowel syndrome is rare with proper bowel-sparing technique 2

Risk Factors for Poor Outcomes

• Presence of associated congenital anomalies significantly increases mortality risk 1
• Prematurity and low birth weight are additional risk factors for complications 4
• Multiple atresias or more severe variants (types III-IV) carry worse prognosis than isolated type II 1

Critical Pitfalls to Avoid

• Never delay surgical intervention once the diagnosis is established, as this increases morbidity and mortality 5
• Do not attempt conservative management with nasogastric decompression alone—jejunal atresia requires definitive surgical repair 5
• Avoid excessive bowel resection beyond what is necessary to create a functional anastomosis 2
• Do not miss synchronous atresias during initial exploration by failing to examine the entire small bowel 4
• If anastomotic leakage occurs postoperatively, immediate re-exploration is mandatory rather than attempting conservative management with antibiotics alone 5