The initial treatment of choice for a 2.5-kg. infant with a 20.0-cm. long proximal jejunal atresia and 8.0 cm. of distal ileum is:

E. Laparotomy, tapering jejunoplasty, and end-to-oblique jejunoileal anastomosis.

DISCUSSION: The patient has short bowel syndrome with most of the bowel length involving the dilated proximal jejunal atresia. The treatment of choice is to perform a tapering jejunoplasty to preserve bowel length and construct an anastomosis. Early feedings are initiated when bowel function returns in order to stimulate bowel adaptation. Jejunal dilatation will not significantly lengthen the atretic jejunum and will not alter its abnormal motility. End-jejunostomy decompresses the obstruction but produces a high ostomy with excessive loss of succus entericus. A double-barrel enterostomy might allow refeeding of jejunal content into the distal ileum and colon, but the proximal atretic loop may have poor function. Small bowel transplantation is not a feasible alternative in the neonate at the present time.