Multiple Congenital Stenoses of the Ileum in an Adult.

Cases of congenital stenosis and atresia of the small bowel have been well described and documented in children. Atresias obviously will present within the first few days of life and in most cases stenoses also will present early, most usually in the neonatal period. In Gross's series (1953), 50 out of 70 cases of intestinal stenosis presented in the first month of life, whereas only eight presented between the ages of 1 and 9 years. In that series, however, there were six cases of colonic stenosis, the age of presentation not being stated. The age of presentation is obviously governed by the degree of stenosis, and as the majority are severe, they present early. Later presentation is probably due to the change of diet from liquid to solid, superimposed inflammatory change, or the impaction of a bolus of solid food. In a brief review of the literature, no case of congenital stenosis of the small intestine causing symptoms in adult life has been noted. In reviewing series of cases of small intestinal stenoses and atresia by various authors (Forssner, 1906; Davis and Poynter, 1922; Sheldon, 1926; Ehrenpreiss, 1943; Louw, 1952; Gross, 1953; Moore and Stokes, 1953; Weibel, 1955; Feggetter, 1955; Phelan, Lemmer, and McDonough, 1959; Benson, Lloyd, and Smith, 1960), it is seen (Table I) that multiple atresias make up about 20% of all cases of atresia of the small bowel. Others (Davis and Poynter, 1922; Spriggs, 1912) have quoted similar figures. Multiple stenoses of the small gut, however, are extremely uncommon. Moore and Stokes (1953) describe a case of multiple diaphragmatic stenoses of the duodenum and upper jejunum. Gross (1953) and Louw (1952) in their series both include one case each but give no descriptions. Spriggs (1912), Loitman (1927), and Weibel (1955) have described also cases of multiple stenoses associated with areas of atresia. Davis and Poynter (1922) stated that this association was not uncommon but gave no figures. The following case report is of a patient whose symptoms developed in childhood and persisted well into adult life before being diagnosed and treated.