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| Year : 1984 | Volume
: 30
| Issue : 3 | Page : 183-5 |
Intestinal atresia (report of 4 cases).
Dhankar SS, Kant KK, Agarwal RK, Dewal DS
How to cite this article:
Dhankar S S, Kant K K, Agarwal R K, Dewal D S. Intestinal atresia (report of 4 cases). J Postgrad Med 1984;30:183 |
Atresia of any part of the gastrointestinal tract constitutes an important cause of neonatal intestinal obstruction requiring immediate surgical intervention. This congenital malformation can affect any part of the G.I. tract at an isolated or multiple sites. The ileum has the greatest affinity for atresia, with an approximate incidence of 50% of all atresia cases followed by the duodenum and jejunum[4]. Colonic atresia forms about 10% of the total atresia cases[7].
Four cases of neonatal intestinal obstruction were admitted to the surgical wards of this hospital. Their intestinal atresia involved various sites. All four eases presented with complaints of non passage of meconium since birth and distension of abdomen. Two neonates had repeated bilious vomiting (Cases No. 3 and 4). Neonates with colonic obstruction presented late as compared to those with doudenal or jejunal obstruction.
The pre-operative assessment included the correction of dehydration and a plain skiagram of the abdomen in the standing position and barium meal for the stomach and duodenum by Conray via Ryles tubes (Cases 3 and 4). [Fig. 1] & [Fig. 2]. All the cases were then explored on an emergency basis and the types of atresia assessed. Associated anomalies were checked. Appropriate treatment such as ileorectal anastomosis, caecostomy, release of bands and anterior gastro-jejunostomy was instituted depending upon the individual pathology.
The complete clinical picture of the 4 cases of intestinal atresia is presented in [Table - 1]. Associated anomalies, treatment instituted, post-operative complications observed and follow-up results are also shown in [Table - 1]. The Table is self-explanatory.
Congenital atresia of the intestine and colon represents the most frequent cause of intestinal obstruction in a newborn. Its etiology relates to the vascular insufficiency to following vascular accidents like volvulus, intussusception or internal hernia in the intra-uterine period producing aseptic necrosis and absorption of necrotic bowel.[3] The second view is about non-canalization of the primitive gut.[2] Abnormal rotation and fixation of the bowel by dorsal mesentery are also implicated as causative factors.
Intestinal atresias can be classified into 3 major types according to the classification suggested by Bland-Sutton.[1]
Type I: Atresia with a complete occlusion of the intestinal lumen by the diaphragm.
Type II: Atresia with complete occlusion of the intestinal lumen terminating into a blind end and joined by a cord-like structure.
Type III: Atresia with complete occlusion as in Type II but without any connection between the proximal and distal segments and, in addition, a V-shaped defect in the mesentery.
On the basis of this classification, Cases 1 and 2 belonged to Type II as the entire large intestine was atretic from the caecum upto the last 2-3 cm of the rectum and formed a long, string-like structure. Case 3 had a proximal, jejunal atresia of Type III. In this case, the duodenal and jejunal ends were blind with a V-shaped gap in the mesentery and there was no connection between the two segments. Moreover, associated anomalies included a malrotation of the mid-gut with the caecum on the left upper quadrant and the band of Ladd. The 4th case belonged to Type I as there was a septum in the second part of the duodenum below the duodenal papilla but no other associated anomaly.
Early detection of intestinal atresia is very important for the successful treatment as there is no survival beyond the first week.[5],[6] Complete abdominal exploration, determination of the patency of the distal segment, resection of the distended proximal segment and primary anastomosis are essential for a successful outcome.[6]
In the present series, a caecostomy was done in Case 2 because of the poor general condition of the patient while in Case 1, a primary ileorectal anastomosis was successfully done. In Case 3, after releasing the band of Ladd and ascertaining the site of atresia, an anterior gastrojejunostomy was done. Duodenostomy or duodenojejunostomy could not be done due to technical reasons and the poor condition of the neonate. Similarly in Case 4, instead of duodenojejunostomy, an anterior gastrojejunostomy was done.
Post-operatively, all the four cases passed meconium after an interval of 48 to 72 hours. Case No. 3 developed severe kernicterus on the 6th post-operative day and expired on the 9th post-operative day.
Cases No. 1 and 4 are still available for follow-up in a good health. Case No. 2 with caecostomy is due for 2nd stage ileorectal anastomosis.
| 1. | Bland-Sutton, J. D.: Imperforate ileum. Amer. J. Med. Sci., 98: 457-462, 1889. Quoted by Harbour et at (1965)[5].  |
| 2. | Brenner, J. L.: "Congenital Anomalies of Viscera." Harward Press, Cambridge, 1957. |
| 3. | Dunphy, J. E. and Way, L. W.: "Current Surgical Diagnosis and Treatment." Maruzen Asian Edition, Lange Medcal Publications, Maruzen Company Ltd., Sanfransisco, 1973, p. 1017. |
| 4. | Haller, A.: Paediatric Surgery. Chapter 39, In, "Principles of Surgery". Editors: S I., Schwartz, R. C Lillehei, G. T. Shires, F. C. Spencer and E, H. Storer, McGraw Hill Book Company-A Blackiston Division, New York, London and Johannesburg, 1974, pp. 1631-1665. |
| 5. | Harbour, M. J., Altman, D. H. and Gilbert, M.: Congenital atresia of the colon. Radiology, 84: 19-23, 1965 |
| 6. | Peck, D. A., Lynn, H. B. and Harris, L. E.: Congenital atresia and stenosis of the colon. Arch. 5urg., 87: 428-439, 1963. |
| 7. | Pollock, W. F. and Bergin, W. F.: Management of intestinal atresia at the Los Angeles Children's Hospital, Amer, J. Surg., 102: 202-216, 1361. |
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