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PubMed1979

[Prenatal diagnosis of an intestinal atresia by means of ultrasound - case report and discussion (author's transl)].

An intestinal atresia was diagnosed by means of ultrasonography and amniofetography in the 34. gestional week. The discussion agendas are, how far the given ultrasonogramms are typical for fetal intestinal atresia and how much part was played by sonography and amniofetography by the search of diagnosis; further, whether already antenatal diagnosed intestinal abnormality justifies a fetal indicated cesarean section, which could be important for timing of the surgical performance and for the betterment of the perinatal situation.

Adult↗
PubMed2003

Fetal hemorrhage associated with congenital intestinal atresia.

We encountered two cases of severe intrauterine hemorrhage associated with congenital intestinal atresia. In both cases, the first sign that necessitated immediate clinical management was the abnormal fetal heart rate patterns, represented by prolonged bradycardias and late decelerations. This occurred immediately after the onset of labor. An emergency cesarean section was performed on both patients and, despite being born with severe anemia, the condition of the infants was excellent. We found that continuous fetal heart rate monitoring should be performed if polyhydramniosis suspected, when the fetus is diagnosed with congenital intestinal atresia and when changes in intrauterine pressure are clinically expected, such as at the onset of labor or after amniocentesis.

Adult↗
PubMed1993

Descriptive epidemiology of small intestinal atresia, Atlanta, Georgia.

To describe the epidemiology of small intestinal atresia (SIA) in Atlanta, Georgia, from 1968 through 1989, we used the Metropolitan Atlanta Congenital Defects Program, an active, population-based surveillance system for birth defects diagnosed during the first year of life. We identified 176 infants with SIA, a prevalence of 2.8 per 10,000 livebirths. Among black infants, the prevalence was 3.7 per 10,000 livebirths, significantly higher than the prevalence of 2.4 per 10,000 among white infants [relative risk (RR) = 1.6, 95% confidence interval (CI) = 1.1,2.1]. Nine infants were each one member of a unique pair of twins. The prevalence among twin infants was 7.3 per 10,000, significantly higher than the prevalence of 2.8 per 10,000 among singletons (RR = 2.7, 95% CI = 1.4,5.2). Forty-nine percent of the infants had duodenal atresia, 36% had jejunal atresia, and 14% had ileal atresia. Two infants (1%) had atresia at an unspecified site in the small intestine. We grouped the infants by anatomic location of SIA into four categories: isolated SIA (53%), SIA with multiple unrelated defects (21%), sequences (16%), and syndromes (10%). We then compared the isolated and multiple unrelated defects groups by gender, race, maternal age, birth weight and one-year mortality for each location of SIA. Among black infants the prevalence of isolated jejunal atresia was 1.4 per 10,000, significantly higher than the prevalence of 0.2 per 10,000 among white infants (RR = 6.3, 95% CI = 2.9, 13.5). The increased prevalence of these defects among twins was a particularly interesting finding.

Adolescent↗
PubMed1986

Intestinal atresia and stenosis: a review comparing its morphology.

A review of the literature on intestinal atresia of domestic animal species and humans was done. The 5 types of intestinal occlusions described in human infants are atresia type 1, atresia type 2, atresia type 3, stenosis, and the "apple peel" or "Christmas tree" deformity. The intestinal defects described in domestic animal species such as the bovine, equine and porcine are similar to those of human infants. The "T-formation", an intestinal defect of the bovine resembling atresia type 3, and rectal stricture, an acquired intestinal defect of the porcine resembling stenosis, were described recently. Intestinal atresia is similar in several species and these similarities raise the questions as to whether the pathogenic mechanism and possibly etiologies of intestinal atresia are similar in these species.

Animals↗
PubMed1980

Intestinal atresia and stenosis in animals: a report of 34 cases.

Intestinal atresia was found in 29 animals and stenosis in five. Atresia was found in the duodenum in one pup; in the jejunum in nine calves, two lambs and one piglet; in the ileum in one pup, one lamb and one piglet; and in the colon in one foal, seven calves, one lamb, one piglet and three kittens. Stenosis was found in the duodenum of a foal, in the jejunum in two calves and one pup, and in both the ileum and the colon of a kitten. One lamb showed ileal atresia as well as ileal stenosis. We classified the atresia as type 1, membrane atresia (four cases); type 2, cord atresia (six cases); and type 3, blind-end atresia (19 cases). In the literature and our own study, atresia was found only in the small intestine in puppies, but in foals and kittens it was found only in the colon. Atresia of the colon is more common in animals than in man, but multiple atresia, frequent in man, is rare in animals.

Animals↗
PubMed1980

[Ultrasonographic diagnosis of a stenocephalus in combination with intestinal atresia (author's transl)].

Microcephalus and atresia of the small intestines can be demonstrated by ultrasonic examination. Malformations can occur at any time during pregnancy. The reasons for it are hard to find. A single diagnostic including ultrasonic investigations, chromosome analysis and alpha-fetoprotein determination in the amniotic fluid during the first half of pregnancy is unsufficient and leads to pseudosecurity. The ultrasonic investigation by an experienced means a marked enrichment of the prenatal diagnostic. Every ultrasonic examination during pregnancy should consider these diagnostic possibilities.

Adult↗
PubMed1985

A 13q- syndrome with extensive intestinal atresia.

The first autopsy case of a 13q- syndrome with extensive intestinal atresia, viz., absence of almost the entire jejunum and ileum, is reported. The absence of the mesentery and the histological properties of the intraperitoneal string-structures composed of some muscle layers resembling the tunica muscularis of the alimentary tract suggest that one of the causative agents of the atresia may be abnormalities of mesenteric vessels.

Abnormalities, Multiple↗
PubMed1998

Intestinal atresia and stenosis: a 25-year experience with 277 cases.

OBJECTIVE: To evaluate the causes, clinical presentation, diagnosis, operative management, postoperative care, and outcome in infants with intestinal atresia. DESIGN: Retrospective case series. SETTING: Pediatric tertiary care teaching hospital. PATIENTS: A population-based sample of 277 neonates with intestinal atresia and stenosis treated from July 1, 1972, through April 30, 1997. The level of obstruction was duodenal in 138 infants, jejunoileal in 128, and colonic in 21. Of the 277 neonates, 10 had obstruction in more than 1 site. Duodenal atresia was associated with prematurity (46%), maternal polyhydramnios (33%), Down syndrome (24%), annular pancreas (33%), and malrotation (28%). Jejunoileal atresia was associated with intrauterine volvulus, (27%), gastroschisis (16%), and meconium ileus (11.7%). INTERVENTIONS: Patients with duodenal obstruction were treated by duodenoduodenostomy in 119 (86%), of 138 patients duodenotomy with web excision in 9 (7%), and duodenojejunostomy in 7 (5%) A duodenostomy tube was placed in 3 critically ill neonates. Patients with jejunoileal atresia were treated with resection in 97 (76%) of 128 patients (anastomosis, 45 [46%]; tapering enteroplasty, 23 [24%]; or temporary ostomy, 29 [30%]), ostomy alone in 25 (20%), web excision in 5 (4%), and the Bianchi procedure in 1 (0.8%). Patients with colon atresia were managed with initial ostomy and delayed anastomosis in 18 (86%) of 21 patients and resection with primary anastomosis in 3 (14%). Short-bowel syndrome was noted in 32 neonates. MAIN OUTCOME MEASURES: Morbidity and early and late mortality. RESULTS: Operative mortality for neonates with duodenal atresia was 4%, with jejunoileal atresia, 0.8%, and with colonic atresia, 0%. The long-term survival rate for children with duodenal atresia was 86%; with jejunoileal atresia, 84%; and with colon atresia, 100%. The Bianchi procedure (1 patient, 0.8%) and growth hormone, glutamine, and modified diet (4 patients, 1%) reduced total parenteral nutrition dependence. CONCLUSIONS: Cardiac anomalies (with duodenal atresia) and ultrashort-bowel syndrome (<40 cm) requiring long-term total parenteral nutrition, which can be complicated by liver disease (with jejunoileal atresia), are the major causes of morbidity and mortality in these patients. Use of growth factors to enhance adaptation and advances in small bowel transplantation may improve long-term outcomes.

Colonic Diseases↗
PubMed1996

Umbilical cord ulceration and intestinal atresia.

Umbilical ulceration is an extremely rare complication in the perinatal period. We encountered a case of intestinal atresia complicated by massive intrauterine hemorrhage due to the umbilical cord ulceration. This is the fifth reported case demonstrating an association between the umbilical cord ulceration and intestinal atresia.

Adult↗
PubMed2006

A proposed classification system for familial intestinal atresia and its relevance to the understanding of the etiology of jejunoileal atresia.

Familial cases of the various types of intestinal atresia are well described, and we now report an additional family. Based on a review of the literature, a classification system for the different types of familial atresia is presented. Current teaching attributes most jejunoileal atresias to in utero vascular accidents occurring relatively late in gestation (after the 11th or 12th week). Although some cases clearly occur this way, as a result of processes such as volvulus and intussusception, knowledge of the familial form of the disease indicates that most cases of jejunoileal atresia actually result from disruption of a normal embryologic pathway, most likely the development of the superior mesenteric artery and its branches. They should be considered to be true embryologic malformations rather than acquired lesions.

Humans↗
PubMed1999

40 years' review of intestinal atresia.

OBJECTIVE: To analyze the 40 years' experience of intestinal atresia and to introduce a new design of long-oblique anastomosis for disproportional loops of the intestine. METHODS: A total of 449 cases of congenital atresia of the small intestine were classified into three groups according to the embryopathology: high group (145 cases), including duodenal and high jejunal atresia; middle group (288), including ileo-jejunal atresia; and low group (16), including terminal ileal atresia. To analyze the survival rate and mode of treatment, we assigned the cases into 3 groups according to the year of admission: 1) 1956-1969 (173 cases), under the general pediatric surgical care; 2) 1970-1985 (147), under the specialty neonatal surgical care; and 3) 1986-1996 (129), with additional use of total parenteral nutrition. RESULTS: The ileojejunal atresia group (middle group) had the highest mortality rate (47.6%). The overall mortality rate decreased as the time went by, dropping from 64.7% in the early years down to 18.6% in the recent years, and no hospital death occurred in the recent couple of years. CONCLUSION: Besides the improvement of neonatal surgical techniques, selecting a proper surgical procedure according to the embryopathology is essential to the reduction of mortality. The long-oblique anastomosis is particularly acceptable in China at present for marked disproportional loops.

Anastomosis, Surgical↗
PubMed1992

Hirschsprung's disease: a possible cause of anastomotic failure following repair of intestinal atresia.

Despite several reported cases, the association of Hirschsprung's disease and intestinal atresia is not widely recognized. We describe three patients with jejunoileal atresia who all had a preoperative barium enema that failed to show a transition zone. All three patients developed an anastomotic leak of the atresia repair, and required a temporary diverting enterostomy. Two patients had total colonic Hirschsprung's disease and in one, the transition zone was in the midtransverse colon. Histological examination of the appendix at the time of repair may be helpful in patients with small intestinal atresia. In patients who develop an anastomotic breakdown, rectal biopsy should be performed to rule out Hirschsprung's disease.

Anastomosis, Surgical↗
PubMed1998

Gastroschisis and total intestinal atresia.

Gastroschisis is an uncommon condition which is now being detected at an earlier stage due to the use of routine antenatal ultrasound scanning. The presence of intestinal atresia secondary to impairment of the vascular supply is well recognised and is associated with a poorer outcome because of the potential for loss of bowel length. We report a case of gastroschisis in which there was resorption of the bowel and closure of the abdominal wall defect. At laparotomy there was total intestinal atresia.

Adult↗
PubMed1993

Multiple areas of intestinal atresia associated with immunodeficiency and posttransfusion graft-versus-host disease.

We describe an infant with multiple segmental areas of atresia of the small and large bowel, with histologic features characteristic of the hereditary form of the disease. Posttransfusion graft-versus-host disease developed first, and then immunodeficiency was found. This report confirms the association between hereditary multiple intestinal atresia and immunodeficiency. We recommend irradiation of blood products in patients with multiple intestinal atresia pending evaluation of immune system status.

Erythrocyte Transfusion↗
PubMed1998

Management of multiple intestinal atresias and perforation with intraluminal stenting.

Intraluminal stenting of the gastrointestinal (GI) tract in both multiple intestinal atresias and perforations was used in three patients. In the atresia patients (2), a piercing trocar was used to create continuity of the GI tract and as a guide to thread the intestine over the stent. All patients currently demonstrate normal growth and development on routine enteral feeds. None developed anastomotic leaks or strictures.

Humans↗