The main congenital problems directly affecting the small intestine from the duodenojejunal flexure down to the cecum are atresia and stenosis. Jejunoileal atresia occurs more commonly than its duodenal counterpart, with an incidence varying from 1 in 330 to 1 in 3000 livebirths.11 Such lesions are one of the most common causes of neonatal intestinal obstruction. The major difference between atresias of the ileojejunum and those of the duodenum is in their etiology. It is postulated that atresia or stenosis of the jejunum and ileum is the result of a localized intravascular accident during intrauterine life. Subsequent ischemic necrosis and reabsorption of the affected segment or segments results in a contracted scarred bowel wall leading to stenosis at one end of the spectrum to a complete intestinal and mesenteric defect at the other. Fetal animal experiments have confirmed this hypothesis, at least in part,12 and the absence of other congenital abnormalities found in association with jejunoileal stenoses and atresias supports the localized vascular accident theory.
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