intestinal atresia

Duodenal atresiaDuodenal atresia
 1:6000-1:100001:6000-1:10000
 Common site of neonatal intestinalCommon site of neonatal intestinal
obstructionobstruction
 Survival ~95%Survival ~95%
 Associated anomalies- 50%Associated anomalies- 50%
 Down’s synd- 30%Down’s synd- 30%
WWW.SMSO.CCWWW.SMSO.CC

EmbryologyEmbryology
 44thth
week- gut formsweek- gut forms
 66thth
week- proliferation of gut epitheliumweek- proliferation of gut epithelium
-- obstruction of lumenobstruction of lumen
 Recanalization failureRecanalization failure  duodenalduodenal
atresiaatresia

TypesTypes
 Complete 80%, incomplete 20%Complete 80%, incomplete 20%
 Gray & SkandalakisGray & Skandalakis
– Ty1 - web/ septum- 90%, no muscle/Ty1 - web/ septum- 90%, no muscle/
mesenteric defectmesenteric defect
– Ty 2 – cord connects two blind ends-2%,Ty 2 – cord connects two blind ends-2%,
no mesenteric defectno mesenteric defect
– Ty 3- v shaped mesenteric defectTy 3- v shaped mesenteric defect

Clinical featuresClinical features
 Antenatal diag-Antenatal diag-
– ““double bubble”double bubble”
– polyhydramniospolyhydramnios
 Post natal-Post natal-
– bilious vomitingbilious vomiting
– Upper abd fullnessUpper abd fullness
– Aspirate> 30 ml , biliousAspirate> 30 ml , bilious

InvestigationInvestigation
 X Ray Abd-X Ray Abd-
– double bubbledouble bubble
– +/- distal gas+/- distal gas
 Evaluate for Down’s syndEvaluate for Down’s synd

ManagementManagement
 NOT a surgical emergencyNOT a surgical emergency
 NG/OG aspirationNG/OG aspiration
 IV fluidIV fluid
 Temperature controlTemperature control
 TPNTPN

Surgery- Kimura’sSurgery- Kimura’s
duodenoduodenostomyduodenoduodenostomy

ComplicationComplication
 Leak/ obstructionLeak/ obstruction
 Feed intoleranceFeed intolerance

Intestinal atresiaIntestinal atresia

Jejunoileal atresiaJejunoileal atresia
 Atresia- obstruction due to completeAtresia- obstruction due to complete
occlusion of lumen, 95%occlusion of lumen, 95%
 Stenosis- partial intestinal obstructionStenosis- partial intestinal obstruction
due to subtotal occlusion of lumen, 5%due to subtotal occlusion of lumen, 5%
 Maternal use of psuedoephedrine,Maternal use of psuedoephedrine,
ergot,caffeineergot,caffeine

EmbryologyEmbryology
 Mesenteric Vascular accidentsMesenteric Vascular accidents
 Late pregnancyLate pregnancy
 volvulus, gastroschisis, omphalocele,volvulus, gastroschisis, omphalocele,
internal herniasinternal hernias
 Louw & Bernard experimentsLouw & Bernard experiments

Clinical featuresClinical features
antenatal USG- poor predictivevalueantenatal USG- poor predictivevalue

ExaminationExamination
 DistentionDistention
 Dilated veinsDilated veins
 Visible bowel loopsVisible bowel loops
 Visible peristalsisVisible peristalsis
 Signs appear 12-24 hr after birthSigns appear 12-24 hr after birth

InvestigationInvestigation
 X ray abd- erect/ supineX ray abd- erect/ supine
– Dilated bowel loopsDilated bowel loops
– AF levelsAF levels
– Paucity of gas beyond obstructionPaucity of gas beyond obstruction
– Abd calcification/ intraluminal calcificationAbd calcification/ intraluminal calcification

Differential diagnosisDifferential diagnosis
 Meconium ileusMeconium ileus
 TCATCA
 Internal herniaInternal hernia
 MalrotationMalrotation
 Colonic atresiaColonic atresia
 DuplicationDuplication
 SepsisSepsis

DistributionDistribution
 Jejunum: ileum-50% eachJejunum: ileum-50% each
 MC- distal ileumMC- distal ileum
 90% single, 6- 20% multiple90% single, 6- 20% multiple

ManagementManagement
 NPONPO
 NG/OG suctionNG/OG suction
 IV fluidsIV fluids
 Temp controlTemp control
 Vit KVit K
 AntibioticsAntibiotics

Surgical optionsSurgical options
 Excision of grossly dilated prox bowelExcision of grossly dilated prox bowel
with end- oblique anastomosiswith end- oblique anastomosis
 Tapering jejunoplasty withTapering jejunoplasty with
anastomosisanastomosis
 Preserve bowel lengthPreserve bowel length
 Other associated anomalies correctionOther associated anomalies correction
 Resection with exteriorization- poorResection with exteriorization- poor
vascularity/ contaminationvascularity/ contaminationWWW.SMSO.CCWWW.SMSO.CC

ComplicationsComplications
 LeakLeak
 ObstructionObstruction
 Sepsis/ peritonitis/pneumoniaSepsis/ peritonitis/pneumonia

intestinal atresia

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