Congenital intrinsic proximal jejunal obstruction caused by a mucosal web near the duodenojejunal junction in a neonate: a case report and literature review

Abstract Congenital intrinsic obstruction at or near the duodenojejunal junction is exceptionally rare and most commonly results from incomplete embryonic recanalization, leading to the formation of a mucosal web. We report a 7-day-old term male neonate (birth weight 3350 g) who presented with persistent feeding intolerance and intermittent bilious vomiting since birth. Abdominal radiography showed marked dilation of the stomach and duodenum with distal bowel gas. An upper gastrointestinal contrast study revealed a conical narrowing at the duodenojejunal junction. Surgical exploration revealed a mucosal web located immediately distal to the duodenojejunal junction. Given the marked luminal disparity, simple web excision was deemed inadequate, and segmental resection with primary end-to-end jejunojejunal anastomosis was performed. Postoperative recovery was uneventful. Proximal jejunal webs near the duodenojejunal junction are rare but surgically correctable causes of neonatal bilious vomiting and should be considered in the differential diagnosis.