Intestinal atresia

Abstract

Intestinal atresia accounts for about one third of all cases of neonatal intestinal obstruction. The survival rate has improved to 90% in most of the series with the operative mortality being < 1%. The survival rate improves with distal atresias. An increased mortality is observed in multiple atresias (57%), apple peel atresia (71%), and when atresia is associated with meconium ileus (65%), meconium peritonitis (50%) and gastroschisis (66%). Although appearance of echogenic bowel on prenatal ultrasonography is suggestive of GI, it is confirmed in only 27% cases. Prenatal ultrasonography is more reliable in detection of duodenal atresia than more distal lesions. Short bowel syndrome is the major impediment in the management of jejunoileal atresia. Although total parenteral nutrition (TPN) is the main adjunctive treatment, it delays intestinal adaptation and may cause cholestasia and subsequent liver damage. Graduated enteric feedings, use of growth hormone, glutamine and modified diets containing low fat, complex carbohydrates and protein supplements have been used in a adults with short bowel syndrome to successfully diminish TPN requirements and enhance nutrient absorption in nearly half of the patients. Utilization of growth factors to facilitate intestinal adaptation and advances in small bowel transplant may improve the long-term outcomes in future.

Management of Jejunoileal Atresia : Our 5 year Experience

“…Postoperative complication was less after primary anastomosis and its management was used to be less troublesome. Survival of the neonates with jejunoileal atresia has improved from 64% to 90% in most of the series 6,9,10,16,17 . Probably the most important factor in the improved outlook for infants with jejunnoileal atresia was the ability of adequate support in improving the nutritional status of these patients with total parenteral nutrition and highly defined elemental diets 9,18 .…”

“…The presence of gangrene and perforation of the proximal intestinal segment in jejunoileal atresia is often difficult to select better surgical option between primary anastomosis and enterostomy. Immediate postoperative outcome seems to be satisfactory after enterostomy, but subsequent care of stoma and maintenance of nutritional status is so difficult, that Volume 12, Issue 3, September 2013 most of the survivor not able to reach the next surgical procedure of stomal closure 10 . Improvement in pediatric anesthesia and surgical expertise, presence of effective antibiotics and better understanding of fluid and electrolyte homeostasis; operative time and stability of the patient is a little constraint to the choice of surgical option.…”

Pediatrik Nontravmatik Abdominal Acillere Radyolojik Yaklasim

“…İn-testinal atrezinin tedavisi cerrahi onarımdır. İn-testinal atrezi tedavisi sırasında karşılaşılan en önemli risk kısa barsak sendromudur [11]. Mekonyum ileusu 5000-10000 doğumda 1 görülür.…”

“…Mekonyum peritoniti acil cerrahi gerektiren bir durum olup başlıca radyolojik bulguları; batın içi serbest hava, hava/sıvı seviyeleri ve geç dö-nemde kalsifikasyondur [11,12].…”

Apple Peel Jejunal Atresia in a Neonate: A Rare Cause of Intestinal Obstruction

“…In the 3 rd trimester of gestation,vascular accidents cause ischemia or necrosis of the bowel and its mesentery resulting in atresia. Apple peel variant of jejunal atresia is very uncommon with a reported high incidence of mortality, even though overall survival of intestinal atresia has improved to about 90% 1,2 . We are reporting a case of apple peel jejunal atresia in a preterm boy with brief review of the literature.…”