Total absence of the small-bowel in a newborn with duodenal obstruction a case report and complete review of short bowel syndrome

Total absence of small bowel is very rare situation. It usually accompanied with vascular accident or abdominal wall defect. The following case is presented to discuss the optimal care and best operative technique could be had in this situation. Case: Two-day-old neonate, G/A of 36th weeks, whom was referred to our center because of bilious vomiting and double bubble sign in the X-rays. Patient with diagnosis of duodenal obstruction was resuscitated and was transferred to operating room for exploration. We found adhesion and a sac, which was containing two blind pouches. The proximal was third portion of duodenum and the distal was cecum and 3 cm of terminal ileum. To end the operation duodenocolic anastomosis was performed. Patient transferred to NICU, for parenteral nutrition and discussing the matter with parents. Despite good postoperative course, patient was discharged on parent’s consent on third days and died in home because of neglect. Discussion: Patients with Short bowel syndrome can survive if at least 15 cm of small bowel with intact ileocecal valve or 25 cm small bowel without ileocecal valve are existed. If the above criteria having not been met, it is better to make bowel continuity back, put the patient on parenteral nutrition, then discuss the options of future transplant and costs, complications of prolong parenteralnutrition. These give them the time to adapt and decide