Intestinal Atresia

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What is an intestinal atresia?

Congenital obstruction of the intestine; usually the jejunum, or ileum. Rarely, the colon is involved. Multiple atresias may be present, but this is uncommon.

What are the causes and incidence of intestinal atresia?

Intestinal atresia is thought to arise from an in-utero vascular occlusion of the blood supply to the bowel. The affected bowel either scars to a fibrotic stricture or may be reabsorbed. The defect occurs late in gestation and therefore, is not typically associated with other anomalies.

What are the symptoms?

If the defect is high in the intestine, polyhydramnios (too much fluid) may be observed. More often the infant presents on the second or third day of life with bilious vomiting. The infant may pass mucoid stool but does not pass normal meconium after birth. As the infant swallows more air and feeds, the abdomen becomes enlarged (distended). The diagnosis is suggested by X-ray that demonstrates dilated intestinal loops. The diagnosis is confirmed with a barium enema that typically shows a micro-colon that results from lack of use due to the proximal obstruction of the small intestine.

What is the treatment?

Your infant requires surgical correction of this condition by alleviating the obstruction and restoring intestinal continuity. Since the proximal bowel is dilated and dysfunctional, a limited resection of the bulbous segment is performed. If possible, an anastomosis is performed, although significant size disparity still exists between the proximal and distal intestine. Postoperatively, a nasogastric tube is placed to permit decompression of the bowel until intestinal function returns. Feedings are carefully started after signs of peristalsis occur, as indicated by: 1) clear, low-volume nasogastric output, 2) a nondistended abdomen, and 3) evidence that the baby is passing flatus or stool.

Achieving full oral feedings may take several days (mean, 5-7) or longer, even months. Infants in whom return of intestinal function is predicted to be prolonged, nutrition is provided by vein (TPN) and will require placement of a central venous catheter. In some cases, an anastomosis can not be performed and intestinal stomas are created to permit the bowel to decrease in size proximally and promote growth of the distal bowel with saline irrigations. Once the bowel caliber is comparable, the baby is returned to the OR for takedown of the stomas and anastomosis.

What is the expected outcome?

Overall survival for this condition is excellent, greater than 95%.

 

What are the complications?

  • Anastomotic leak or narrowing (stricture)
  • Intestinal dysfunction
  • Short bowel syndrome

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