case_images: PMC11251804_01
case_images: (
  A
  ) Fluoroscopy showing dilated jejunal loop proximal to the jejunostomy occupying the entire central abdomen. In addition, there is residual colon to the splenic flexure. (
  B
  ) Contrast enema showing residual segment of narrowed descending colon and proximal sigmoid colon. (
  C
  ) Contrast enema confirming dilated jejunal loops proximal to jejunostomy found on prior fluoroscopy.
case_images: 10-1055-a-2351-9413-i2023120743cr-1.jpg
case_images: PMC11251804_01_10-1055-a-2351-9413-i2023120743cr-1.jpg
case_images: FI2023120743cr-1
case_images: He was found to have a significantly dilated proximal jejunal loop on initial upper gastrointestinal fluoroscopy ( Fig. 1A ). Retrograde contrast enema showed a narrowed segment of retained descending colon and proximal sigmoid colon ( Fig. 1B ). A contrast study via the jejunostomy confirmed the previously identified dilated jejunal loops, which was measured to be about 7 cm on the initial fluoroscopy ( Fig. 1C ).
case_images: (
  A
  ) Jejunum twisted 360 degrees as it entered the jejunostomy. (
  B
  ) Result of STEP procedure on dilated jejunum, allowing for narrowing and lengthening of dilated colon. STEP, serial transverse enteroplasty.
case_images: 10-1055-a-2351-9413-i2023120743cr-2.jpg
case_images: PMC11251804_01_10-1055-a-2351-9413-i2023120743cr-2.jpg
case_images: FI2023120743cr-2
case_images:  At the time of surgery, a 360-degree twist of the jejunum proximal to the ostomy was incidentally identified, which was likely causing poor intake and the dilation previously described ( Fig. 2A ). The STEP of the dilated segment of jejunum enabled the simultaneous narrowing and lengthening of the dilated segment to 45 cm for a total small bowel length of 139 cm ( Fig. 2B ).