Jejuno-ileal atresia: A 2-year preliminary study on presentation and outcome (original) (raw)
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Jejunoileal atresia: a case-series of 63 neonates and risk factors to mortality
Introduction: Jejunoileal atresia (JIA) among neonates is still a condition which has huge morbidity and mortality, particularly in the developing world. We share a case series of JIA in context of their presentation, management, and outcome. Materials and methods: This study was conducted at Children's Hospital and Institute of Child Health, Lahore, over 1 year. We included all patients presenting with JIA, and their demographic details, presentation, investigations, treatment strategies, and the outcome were noted at a pre-designed proforma. All data were analyzed using SPSS version 26. Results: A total of 63 neonates with JIA were included. Most of them (79.4%) presented after 48 h of life, and the mean age at presentation was 5.68 ± 4.75 days. There were 37 male patients (58.7%), and 51 (81%) were full-term. The most common presenting complaint was not being able to pass meconium (88.9%). Type III atresia was the most common subtype (41.3%). Most of them underwent resection without tapering. The mean hospital stay was 12.81 ± 6.53, and it was significantly longer among those who underwent re-exploration (P = 0.034). Twenty-three patients (36.5%) expired within 6 months of follow-up. The only significant factor for mortality was the presence of short bowel syndrome (P = 0.030). All other demographic and management factors did not alter the mortality rate. Conclusion: Management of surgical neonates is a difficult job in developing countries with limited resources. There is a high mortality rate of neonates following JIA surgeries, and surgeons in these countries must fight on many fronts to improve the outcome.
Intestinal atresia: management problems in a developing country
Pediatric Surgery International, 2004
Intestinal atresia ranks as the second most common cause of neonatal intestinal obstruction (after anorectal malformation) in our hospital. Five children had duodenal obstruction (two atresia, two duodenal webs, one annular pancreas), 17 had jejunoileal atresia, and two had colonic atresia. Fourteen were boys, and 10 were girls (M:F: 1.17:1). The median age at presentation to the surgeon was 6 days (range: 1 day-12 years). The most common presenting features were bilious vomiting and abdominal distension. Six patients did not pass meconium within the first 24 h of birth. The median weight at presentation was 2.6 kg (range: 1.1 kg-5.0 kg). Seven patients (four with jejunoileal atresia and three with duodenal obstruction) had associated congenital anomalies. Diagnostic investigation was plain abdominal x-ray, showing doublebubble gas shadows in duodenal atresia and varying degrees of air-fluid levels in jejunoileal and colonic atresias. An upper gastrointestinal series was done in three patients and a barium enema in one. Retrocolic duodenojejunostomy was done for all patients with duodenal atresia and annular pancreas, duodenotomy and web excision for those with duodenal webs, and resection with end-to-end anastomosis for those with jejunoileal atresia. One child with atresia involving the whole ileum and the colon had a jejunorectal anastomosis, while the other child with colonic atresia had caecostomy followed later by ileorectal anastomosis. Ten neonates died, giving a mortality rate of 41.7%. Mortality from intestinal atresia is still high in our environment, due mainly to lack of neonatal intensive care facilities.
Management of jejunoileal atresias: an experience at eastern Nepal
BMC Surgery, 2010
Background Intestinal atresia is a common cause of neonatal intestinal obstruction, and management of this disease in limited setup of a developing country is very difficult. Methods This study is a retrospective study of patients with jejunoileal atresias and their postoperative outcome in a teaching hospital in eastern Nepal over a 5-year period. Results There were 28 children (19 boys and 9 girls). 11 children (39.28%) had jejunal atresia and 17 (60.71%) had ileal atresia. Eight (28.5%) patients died, 6 were jejunal atresia (54.5%) and 2 were ileal atresia (11.7%). The most common cause of death was sepsis which occurred in 7 out of 8 cases (87.5%). The risk factors for mortality identified were leucopenia, neutropenia, delay in surgery, location of atresia and type of atresia. Jejunal atresia tended to have a higher mortality than ileal atresia, and severe types of atresia (type IIIb and IV) were more often associated with mortality than other types of atresia. The significant differences between jejunal and ileal atresia were the increased duration between presentation and surgery, longer postoperative and total hospital stay, presence of more severe atresias and an increased risk of mortality in case of jejunal atresias. Conclusion The prognosis for this disease have definitely changed in the last few decades in developed countries but in our environment, problems like late presentation and diagnosis, lack of availability of good neonatal intensive care units and parenteral nutritional support still prevail.
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
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.
Neonatal Intestinal Obstruction
Aim: To study the clinical presentation, etiology, management and outcome of neonatal intestinal obstruction in children less than 28days old over a period of 5years in our department and review of relevant literature. Materials And Methods: It is a prospective study of 100 children within 28 days of birth with intestinal obstruction were managed from May 2010 to May 2015 at our department of paediatric surgery. Excluded from this study Anorectal malformations and Hirshsprungs disease. Results: The commonest cause was intestinal atresia 53, pyloric atresia/web one, duodenal atresia/web 17, jejuna atresia 15, ileal atresia 14, colon atresia 3, rectal atrsia one, multiple site atresias two, followed by malrotation and mid gut valvulus 22,Meconeum ileus 11, pneumoperitonium and peritonitis 5, gastric peraforation 3, anular pancreas 2, meckles diverticulum one, NEC 3. Out of100 neonates there were 65 males and 35 females. The mortality rate was 26%. Conclusions: Intestinal obstruction is a common neonatal surgical emergency at our centre. The incidence is higher in males than females. Abdominal distension, vomiting and constipation are the predominant presenting features. Intestinal atresias are the commonest types of neonatal intestinal obstruction 53%, and malrotation and midgut valvulus 22%, Meconium ileus 11% and pneumoperitonium and peritonitis 5% are the next commontypes in our study. Mortality is significantly higher in those who present late >72 hours than in those presenting between 24 to 72 hours. Higher mortality was noted in patients presenting late and jejunal atresia, multiple atrsias, low birth Wight, perforation, peritonitis and septicemic shock. Early diagnosis , surgical management and Neonatal intensive care management can reduce mortality.
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...
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.