Intestinal atresia: management problems in a developing country (original) (raw)
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Jejuno-ileal atresia: A 2-year preliminary study on presentation and outcome
Nigerian Journal of Clinical Practice, 2012
Background/Aim: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejuno-ileum is the commonest site of intestinal atresia. Reports on Jejunoileal atresia in developing countries are still few. The purpose of this study is to determine the presentation and management outcomes of neonates with Jejunoileal atresia treated in our hospital. Materials and Methods: Detailed data on all babies that presented and were treated within the study period (November2008-November, 2010) were kept and analyzed. A management protocol was put up and maintained. Result:A total of 9 babies (7males and 2 females) were treated. They were aged 2hours to 13days. Their weight ranged from 1.7kg to 3.3kg. Apart from one baby which presented within 2hrs with prenatal ultrasound diagnosis, others had bilious vomiting from the first day of birth, abdominal distension and delayed or absent passage of meconium. Even though symptoms developed on the first day of birth, presentation to the surgical unit was delayed 72hours and beyond in most patients.Type I atresia is commonest (no=4).There is associated gut malrotation in 2 babies. Five babies had complications which included surgical site infection, sepsis, prolonged vomiting post operatively, aspiration, rupture of dilated proximal segment after membrane excision, entero-cutaneous fistula and malnutrition. Three babies died giving a mortality of 33.3%. Mortality is commoner in types IIIb and IV. Conclusion: Mortality is higher in complex atresia which most times will require neonatal intensive care and parenteral nutrition facilities. These are still lacking in our institution. Providing these facilities will further improve outcome.
Ileal Atresia in a 10-day-old male baby: A case report
SAGE Open Medical Case Reports, 2021
Ileal Atresia is noted to be the commonest cause of intestinal obstruction in neonates worldwide but still under diagnosed in Sub-Saharan countries with scarce data reported on its occurrence. It is likely under diagnosed due to low index of suspicion. Advancement in foetal ultrasound during prenatal period will increase index of suspicion and hence early diagnosis and correction. This is the first case report in our setup highlighting this condition. We present a case of a 10-day-old male baby referred to us due to vomiting since birth. Clinically was in distress with a palpable supraumbilical mass that was firm and non-tender. Abdominal ultrasound scan showed poor peristalsis and minimal dilation of bowels suggestive of partial intestinal obstruction. Abdominal X-ray showed dilated bowels with multiple air-fluid levels, empty rectum with features suggestive of intestinal obstruction. Patient was successfully operated but unfortunately on day 3 post-surgery succumbed.
Intestinal Atresia: A Four-Year Review of Cases in Ikeja-Lagos
Journal of Nepal Paediatric Society, 2012
Introduction: Intestinal atresia is one of the most common causes of neonatal intestinal obstruction worldwide. The pattern of presentation and management in our institution is reviewed. The objective of the study was to evaluate the pattern of intestinal atresias and stenoses in newborns who presented to our unit. Materials and Methods: A retrospective study of patients with intestinal atresias and stenoses who presented between September 2004 and November 2008. The clinical presentation, diagnoses, operative management, post operative care and outcome were obtained from the case notes. Results: Thirty cases were seen in that period, M:F; 1:1.5. Eleven (36.7%) were duodenal pathologies and 19 (63.3%) were jejunoileal. The main presenting symptom was bilious vomiting. Overall mortality is 40.9%. Prematurity and delayed presentations are the major contributing factors to mortality. Conclusion: Improvement of health care facilities as well as public health education to seek early inte...
BMC Gastroenterology, 2014
Background: Several types of congenital lesions can cause complete or incomplete obstruction of the intestine. Our purpose is to present 3 neonates with dual intestinal type I atresia, i.e., simultaneous obstructive lesions at 2 locations in which the atresia manifested as diaphragm-like tissue. Case presentation: All 3 cases were female infants ranging in age from 2 to 14 months. The common symptom in all cases was intermittent persistent vomiting. In some cases the vomitus was bilious, and other symptoms included abdominal distention and delayed meconium passage. Prior surgeries at another hospital were unsuccessful at relieving the symptoms in one case. One case had dual lesions in the colon, one dual lesions in the duodenum, and one atresia at both the distal portion of the ileum and the descending colon. Surgical exploration and removal of the lesions at our hospital was successful in all cases, and the infants were discharged in good condition. Conclusions: Type I atresia can manifest as a diaphragm-like tissue obstructing the continuity of gastrointestinal tract, and in rare cases multiple areas may be present. Base on the intermittent nature of the associated symptoms, diagnosis can be difficult and is often delayed. Physicians should be aware of this condition during the work-up of an infant with persistent intermittent vomiting.
2020
Basnet AT, Thapa B, Dhoubadel P, Kayastha A. Five years experiences in the diagnosis and management of jejuno-ileal atresia in Kanti Children’s Hospital. J Soc Surg Nep. 2020 Dec;23(2):4-8. Introduction: Jejuno-ileal atresia is a major cause of neonatal intestinal obstruction. The aim of this study is to evaluate the incidence, clinical presentation, management, and outcome of jejunoileal atresia at our institute over a period of five years.
Colonic atresia: surgical management and outcome
Pediatric Surgery International, 2001
Colonic atresia (CA) is a very rare cause of intestinal obstruction, and little information has been available about the management and predictors of outcome. A retrospective clinical trial was performed to delineate the clinical characteristics of CA with special emphasis on surgical treatment and factors aecting outcome. Children with CA who were treated in our department between 1977 and 1998 were reviewed: 14 boys and 4 girls aged 1 day to 5 months. All but 2 referred patients and 1 with prenatal diagnosis presented with intestinal obstruction. Plain abdominal X-ray ®lms showed ®ndings of intestinal obstruction in 14 cases; a barium enema demonstrated a distal atretic segment and microcolon in 4. The types of atresia were IIIa (n 9), I (n 6), and II (n 3). Type IIIa atresias were located proximal to the splenic¯exure (n 8) and in the sigmoid colon (n 1), type I atresias were encountered throughout the colon; and all type II atresias were proximal to the hepatic¯exure. Associated anomalies were multiple small-intestinal atresias (MSIA) (n 4), gastroschisis (GS) (n 2), pyloric atresia (n 1), Hirschsprung's disease (n 1), and complex urologic abnormalities (n 1). The initial management was an enterostomy in 15 patients (83%), including 2 referred and 2 with GS, and primary anastomosis in the remaining 3 (17%). Secondary procedures were the Santulli operation (n 2), colostomy closure and recolostomy followed by a Swenson operation (n 1), sacroabdominoperineal pull-through (n 1), and colostomy closure (n 1). Leakage was encountered in all primarily anastomosed patients. The overall mortality was 61%. Deaths occurred in patients with associated major anomalies (GS 2, MSIA 3, pyloric atresia 1) (55%) and in 3 patients who were initially managed by primary anastomosis (27%). Two additional patients died of sudden infant death syndrome (18%). Type I atresia was more common than in previously reported series and was associated with proximal multiple atresias. The initial management of CA should be prompt decompression of the intestine by an ostomy procedure, preferably end-or double-barrel. The type of surgery (primary anastomosis without prior colostomy) and associated abnormalities are the major determinants of poor outcome.
Different varieties of colonic atresia in a series of 13 patients
Annals of Pediatric Surgery, 2013
The aim of this study was to review our experience in the management and outcome of colonic atresia, either isolated or associated with anorectal anomalies. Methods A total of 13 neonates with colonic atresia were operated upon in the Pediatric Surgery Unit of Zagazig University Hospital between August 2004 and April 2010. Complete data including age, sex, clinical findings, diagnostic procedure, associated anomalies, preoperative management, intraoperative findings, operative procedures, postoperative course, and outcome were reported for each patient. Results Colonic atresia was found in 13 patients, including nine boys (69.2%) and four girls (30.8%). It was located in the ascending colon in four (30.8%) patients, in the transverse colon in three (23%), and in the sigmoid colon in four (30.8%). The other two (15.4%) patients had colonic atresias extending to the small bowel. Two patients had associated anorectal anomalies. Type III colonic atresia was observed in six patients (46.2%), type II in three (23%), and type I in four patients (30.8%). The treatment included resection and primary anastomosis in seven patients (53.8%) and diverting colostomy in six (46.2%). Two patients died: one because of severe neonatal sepsis and the other because of severe cardiac anomalies. One patient developed anastomotic leakage and another had anastomotic dysfunction. Conclusion Colonic atresia is an uncommon cause of neonatal intestinal obstruction. The combination of colonic atresia and anorectal anomalies should be taken into consideration. Proper postoperative care and management of postoperative complications improve the outcome.
Pediatric surgery international, 2024
Intestinal obstruction caused by intestinal atresia is a surgical emergency in newborns. Outcomes for the jejunal ileal atresia (JIA), the most common subtype of atresia in low-income countries (LIC), are poor. We sought to assess the impact of utilizing the Bishop-Koop (BK) approach to JIA in improving outcomes. Methods A retrospective cohort study was performed on children with complex JIA (Type 2-4) treated at our national referral hospital from 1
INCIDENCE AND SHORT-TERM RESULTS OF TREATMENT OF NEONATAL INTESTINAL OBSTRUCTION QR code
Neonatal intestinal obstruction (NIO) is a common and difficult emergency in paediatric surgery. To successfully cope, it is needed to make a quick diagnosis and standard treatment. Management of neonatal intestinal obstruction has improved in many developed countries, but still shows high morbidity and mortality in developing countries. Aim: This study was conducted to assess the incidence and short-term effects of neonatal intestinal obstruction. Place and Duration: In the Department of Paediatric Surgery, Ayub Teaching Hospital Abbottabad for two year duration from March 2017 to March 2019. Methods: This retrospective study involved 84 patients who surgically treated intestinal obstruction during the first month in the emergency department at the Children's Hospital Lahore. Results: Of these 84 patients, 50 are males and 34 females. The average age at the time of presentation was 3.5 (2-10) days for duodenal atresia, 2.5 (3-5) days for jejunoileal atresia, 2 (1-10) days meconium ileus with perforation, volvulus seen in 2 (1-5) days, 7 (5-20) days for colonic atresia, 20 (10-30) days for Hirschsprung disease, 25 (5-30) days for patients with congenital inguinal hernia and 2 (1-4) rectum developmental defects. After resuscitation, all patients underwent surgery. Death occurred in 10 patients (12%). Three patients with atresia of the jejunum had leakage of the anastomosis, underwent a new surgery, but died. Three patients with duodenal atresia died after surgery due to sepsis and DIC. Two patients with major anorectal defects died two days after surgery due to associated cardiac abnormalities, and two patients with sepsis and electrolyte imbalance died after surgery. Conclusion: Anorectal anomalies and congenital inguinal hernia are the most common causes of intestinal obstruction in neonates. Mortality and morbidity remain high compared to statistics from developed countries due to the late presentation and due to improper setting.