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Intestinal Atresia

This document discusses intestinal atresia, specifically duodenal atresia. It begins by defining atresia and stenosis, and noting that duodenal atresia is the most common form of intestinal obstruction in newborns. It occurs due to failure of recanalization during embryonic development when the duodenum temporarily occludes. Clinical features include prenatal polyhydramnios and postnatal bilious vomiting. Diagnosis involves imaging tests showing markers like the double bubble sign. Treatment is duodenoduodenostomy to repair the atresia or stenosis.

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Malueth Angui
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221 views16 pages

Intestinal Atresia

This document discusses intestinal atresia, specifically duodenal atresia. It begins by defining atresia and stenosis, and noting that duodenal atresia is the most common form of intestinal obstruction in newborns. It occurs due to failure of recanalization during embryonic development when the duodenum temporarily occludes. Clinical features include prenatal polyhydramnios and postnatal bilious vomiting. Diagnosis involves imaging tests showing markers like the double bubble sign. Treatment is duodenoduodenostomy to repair the atresia or stenosis.

Uploaded by

Malueth Angui
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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INTESTINAL

ATRESIA
Intestinal atresia

 Atresia is closed/absent opening


 Stenosis is narrowing/obstruction
 Can occur anywhere in the Gi tract
 Duodenum is the most common location, next in frequency is jujenal or ileal
atresia, colon atresia is the most rare
Duodenal atresia

 Most common form of intestinal obstruction in newborns


 Due to failure of recanalization
 In early development the duodenum occludes due to endodermal proliferation of
epithelium, patency is restored by recanalization
Embryology

 During the 4th week the duodenum develops from the endoderm of the primordial gut
of the caudal part of the foregut and cranial part of the midgut from splanchnic
mesoderm.
 The junction of the 2 lies just below or distal to the origin of the bile duct.
 The duodenal loop is formed and projected forward forming a c shaped loop.
 The duodenal loop is rotated with the stomach to the right and comes to lie on the
posterior abdominal wall retroperitoneally.

 During the 5 -6 th week , the lumen of the duodenum is temporarily obliterated


because of proliferation pf its epithelial cells.
 By the end of the embryonic period the duodenum is recanalized by degeneration of
the epithelial cells.
Duodenal atresia

 Its associated with


 Prematurity 46%
 Maternal polyhydramnios 33%
 Low birth weight
 There is also a high incidence of specific anomalies including
 Down syndrome >30%
 Malrotation>20%
 Congenital heart disease 20%
 Other git and renal anomalies
Clinical features

 Prenatal
 Maternal polyhydramnios 30-65%
 Fetal ultrasound Classic double bubble sign
 Post natal
 Majority present within 24-48 hours
 Repeated bilious vomiting. Continuous vomiting can cause gastritis
or blood stained vomitus
Physical Examination

 On examination:
 Epigastric fullness and visible epigastric peristalsis
 Infant may pass normal meconium
 Jaundice may be present
 Feature of down syndrome maybe noted
 Delayed presentation – dehydration and metabolic disturbances
 In partial obstruction/stenosis presentation may be late infants present with recurrent
vomiting, failure to thrive and episodes of aspiration when advancing to more solid foods
Diagnosis

 Prenatal ultrasound: maternal


polyhydramnios, double bubble sign
chromosomal analysis for Trisomy 21
 Postnatal:
 X ray- double bubble sign
Management

Nasogastric decompression
Replacement of iv fluids
Most of the patients are premature and small for gestational age special care must be
taken to prevent hypoglycemia
Procedure of choice is duodenodenostomy for repair of stenosis, atresia or
obstruction
Jejunal ileal colonic atresia

 Thought to be due to an ischemic insult.


 It occurs via vascular disruption causing ischemic necrosis of the intestine.
 Necrotic tissue is resorbed leaving blind ends of the bowel.
 It associate with maternal smoking and vasoconstrictor drugs exposure during
pregnancy.
Classification of jejunal and ileum atresia
 Type I atresia 23% transluminal septum with proximal dilated
bowel in continuity with collapsed distal bowel. The bowel is
usually of normal length
 Type II atresia 10% involves two blind ends separated by a
fibrous cord along the edge of the mesentery with mesentery
intact.
 Type IIIa atresia 15% similar to type II but there is a
mesenteric defect and bowel length maybe shortened
 Type IIb atresia 19% apple peel deformity proximal jejunal
atresia, often with malrotation with absence of most of the
mesentery and a varying length of ileum surviving on
perfusion from retrograde flow along a single artery of supply.
 Type IV atresia, multiple atresias like a sting of sausages,
bowel length is always reduced. Terminal ileum is spared
Clinical Features

 Atresia of the proximal jejunum is often associated with polyhydramnios


 Infants are born prematurely and are often small for their gestational age due to inability to
absorb nutrients from the amniotic fluid in patients with proximal intestinal obstructions
 Postnatal
 Bilious vomiting
 Abdominal distention
 failure to pas meconium. Though you can have passage of a small volume of pale/grey
stool. Passage of meconium doesn’t rule out obstruction
 Jaundice
 Aspiration of >25ml of fluid from the stomach via the NGT is very suggestive of
obstruction.
Physical examination and imaging

 Abdominal distention
 Patients generally don’t have abdominal tenderness or abdominal mass.
Tenderness or peritonitis may develop with complications of ischemia or
perforation
IMAGING

 Abdominal X-ray with Ap view or left lateral decubitus position


 Presence of dilated air-filled intestinal loops and air fluid levels.
 A gastrointestinal contrast meal or enema may be required to confirm and locate
sites of partial obstruction.
 Endoscopy not commonly used
 Rectal biopsy.
 When a neonate doesn't pass meconium in the first 24hrs of life Hirschsprung
disease should be considered in absence of radiological finding suggestive of of
atresia
Management

 Preoperative care involves


 Admission to the neonatal care unit (NICU)
 Nil per oral
 IV Fluid hydration prior to operative intervention
 Nasogastric tube is inserted to clear gastric contents decreasing the risk of
vomiting and aspiration
 Post operative complications include
 Functional obstruction at site of anastomosis
 Anastomotic leak adhesive obstructions
References

 Bailey & Love’s Short Practice of surgery 26th Edition. Chapter 70: Intestinal
obstruction, pages 1193-1194
 Shwartz’s Principles of Surgery 10th Edition. Chapter 39: Pediatric Surgery pages
1724-1725
 Paediatric Surgery: A comprehensive Text for Africa, Volume II. Chapter 62:
Duodenal atresia and stenosis pages 381- 384 Chapter 63:intestinal atresia and
stenosis pages 385-388

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