Under pressure: a contribution to the pathogenesis of acquired ileal atresia

Abstract

An acquired ileal atresia is a rare occurrence. A 3-week-old neonate is presented, who developed postnatally a type 2 ileal atresia and an ileal stenosis within a pre-existing internal hernia secondary to an adhesion band. The literature reports a total of eight cases (4 females) with acquired ileal atresia in babies ranging in age from 3 weeks to 2 years (median 4 months). Mechanical forces (eg, adhesion band, intussusception and volvulus) onto the intestine are most frequently (75%) implicated as the primary event. The distal ileum is most often affected and a type 3A atresia is identified in six of eight (75%) cases.

Figure 1

Graphic illustration of the internal hernia in the distal ileum region with the stenotic segment around 35 cm from the ileocaecal valve (ICV) and the atresia close to ICV.

Figure 2

Surgical specimen of an atretic segment (A) close to the ileocaecal valve with two blind pouches connected by fibrous tissue—(B, H&E, magnification ×5 and arrow)—consistent with a type 2 intestinal atresia.

Figure 3

Surgical specimen (A) of the ileum showing the stenotic region of the ileum. Erosion is seen at the mucosa of the stenotic region (B, H&E staining, magnification ×10 and arrowhead). There is only fibrosis at the serosa (B, H&E staining and double arrowheads) suggesting chronic pressure effect.