Jejunoileal atresia with umbilical entrapment of distal bowel: a rare embryologic insight and surgical challenge

Abstract

Jejunoileal atresia is a common cause of neonatal intestinal obstruction with various etiologies. We report a rare case of type IIIa jejunoileal atresia in which the distal bowel was entrapped within the umbilicus, suggesting failed midgut return during embryogenesis as a possible alternative pathogenic mechanism. A term male newborn presented with progressive abdominal distention and failure to pass meconium within the first 48 hours of life. Imaging studies were consistent with jejunoileal atresia. Intraoperatively, the distal small bowel was found entrapped within the umbilical cord, and a blindending proximal dilated bowel confirmed type IIIa atresia. Resection with end-to-end anastomosis was performed successfully. The patient remained well at the 4-year follow-up. This rare presentation suggests a possible embryologic mechanism of jejunoileal atresia. Caution is advised when evaluating abnormal umbilical cord features in neonates to avoid injury to underlying structures. Despite these unusual findings, bowel resection with primary anastomosis remains the standard treatment, while meticulous assessment of the umbilical cord is essential to prevent iatrogenic intestinal injury.