Isolated apple peel atresia is extremely unusual and has a poor prognosis with mortality rate much higher than simple duodenal or jejunal atresia because of deficient collateral circulation to the small intestine. All gastrointestinal atresias often manifest earlier in life or at birth with signs of bowel obstruction. Such newborns presented with bilious vomiting, abdominal distention, inability to pass meconium, evident intestinal peristalisis, and respiratory distress as a result of significant abdominal distention. The identification of bowel obstruction by obstetric ultrasound varies according to the location of the lesion: 52% duodenal, 40% jejunal-ileal, and 29% bowel [3]. The pathognomonic "double bulla" sign and polyhydramnios in the 3 ed trimester are the best reported markers suggesting the JIA but they are not highly specific or sensitive. The prenatal detection of these congenital abnormalities has a significant impact on the post-natal management, it may influence the mode of delivery and the transfer to pediatric surgical services which can minimize the long-term effects of the anomaly [4]. Although, US continues to be the preferred method of screening for fetal anomalies, in recent years MRI has become an important tool in fetal diagnostics. It provided more accurate finding, it usually shows dilated loops of bowel fluid like throughout the fetal abdomen with a markedly distended stomach and polyhydramnios.

Postnatal diagnosis of intestinal atresias, including JIA, can be established using an X-ray and US scan. Due to the presence of air, the X-ray could reveal enlarged bowel. In addition to detecting atresias, the US scan can offer useful information on stomach movements [5] Intestinal atresias are classified by Grosfeld modified Low classification [6]:

• Type 1: has mucosal atresia,
• Type 2: connected by fibrous bands,
• Type 3: two separate bands with mesenteric defect, 3(a) only defect 3(b) apple peel atresia,
• Type 4: multiple atresia with mesenteric defects The present case is a type of apple peel atresia or Christmas tree atresia or pigtail-like syndrome. They are characterized by bowel occlusion, a mesenteric defect, and the encircling of minuscule bowel loops within an isolated vascular pedicle [7]. The outcome of isolated apple peel atresia is poor, with a complication incidence of 63% and a mortality rate of 54% [8]. After establishing the diagnosis, surgery is the recommended method of treating JIA. The initial step is to explore the abdominal cavity to confirm the diagnosis and exclude out further atresias or gastrointestinal abnormalities (intestinal malrotation and duplication) and the therapeutic objective is to conserve as much bowel as possible. The surgical treatment consists of excision of the dilated end of the bowel and anastomosis with the distal end [9]. Surgical examinations for our patient revealed no intestinal malrotation, duplication, or simultaneous atresia; a jejunal excision was performed with anastomosis. Conclusion Isolated apple peel atresia is extremely rare with poor prognosis, however, prenatal diagnosis of the condition and surgery for the newborn would reduce postsurgical morbidity while offering almost normal quality of life.