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At least 109 records · Page 6Linked to original sources
PubMed2000

Intestinal atresia with gastroschisis: a selective approach to management.

BACKGROUND: The association of bowel atresia with gastroschisis is well recognized, but the ideal management is less certain. METHODS: The records of 10 infants with gastroschisis and intestinal atresia treated between 1991 and 1997 in a single neonatal surgical unit were reviewed. RESULTS: Ten infants had midgut atresias: 5 small intestine, 1 jejunum and colon, and 4 colonic. Of the 6 with small bowel atresias, 4 had primary abdominal wall repair with electively delayed primary anastomosis at 21 to 46 days, 1 had decompressing tube jejunostomy at 11 days at the time of secondary abdominal closure, and 1 initial jejunostomy. Of the 4 with colonic atresia alone, 3 had perforation or infarction of the proximal colon at birth, 2 had a primary stoma, and 2, who did not have initial colostomy or anastomosis, required reoperation for increasing abdominal distension at 11 and 23 days. Complications were recorded in 6 patients: 2 had necrotizing enterocolitis after which 1 developed malabsorption, 1 had distal bowel obstruction after delayed primary anastomosis treated with a Bishop-Koop ileostomy at 50 days, 2 had stoma stenosis, and 1 had stoma prolapse. None died, and at 1 year 9 were within the normal range for body weight, and details of 1 are not known. CONCLUSIONS: At birth, diagnosis of atresia often is uncertain, and the bowel is difficult to repair or exteriorize. For proximal atresias, delayed primary repair is a safe satisfactory approach. At birth, distal atresias are more obvious, often complicated by perforation or infarction, and may benefit from early enterostomy.

England↗
PubMed2003

Multiple intestinal atresia with apple peel syndrome: successful treatment by five end-to-end anastomoses, jejunostomy, and transanastomotic silicone stent.

The association of apple peel bowel with multiple intestinal atresias is a rare event. The authors report a case of a 2.200-g newborn affected by this uncommon condition. The interruptions of small bowel continuity were treated successfully with 5 end-to-end anastomoses and with the construction of 2 ostomies. A gastroduodenal silicone tube (Vygon S.A., Ecouen, France) was used as an intraluminal stent.

Abnormalities, Multiple↗
PubMed1989

Intestinal atresia in calves: 22 cases (1978-1988).

A retrospective study of 22 calves afflicted with intestinal atresia was performed to determine typical signs of disease, treatment, and survival rate. All 22 calves, except 2 heifers with atresia ani and rectovaginal fistula, were examined when they were between 1 and 10 days old because of depression, anorexia, abdominal distention, and lack of feces. All calves had been observed to stand and suckle shortly after birth. Survival rate was influenced by the atretic segment affected: 0% (0/2 surgically treated) for atresia jejunal; 42% (5/12 examined) or 71% (5/7 recovering from general anesthesia) for atresia coli; and 63% (5/8 examined) or 71% (5/7 surgically treated) for atresia ani. Survival appeared to depend principally on early recognition, anatomic site affected, and successful surgical establishment of a patent intestinal tract.

Anastomosis, Surgical↗
PubMed1999

Implications of antenatal diagnosis of small-intestinal atresia in the 1990s.

To assess the prevalence of antenatal diagnosis of small-intestinal atresias (SIA) in the modern era and determine its effect on management and outcome, the records of neonates admitted to a single institution in 1991-1996 with a diagnosis of SIA were reviewed. Duodenal atresia, atresias complicating meconium ileus, and those associated with gastroschisis were excluded. Of 14 neonates with SIA, 10 had jejunal atresia (JA) (Grosfeld type I, n = 1; type II, n = 2; type IIIa, n = 3; type IIIb [apple peel], n = 3; type IV, n = 1) and 4 had ileal atresia (IA) (type II, n = 1; type IIIa, n = 3). Antenatal diagnosis was made in 4 neonates (overall rate = 28%), including all 3 type IIIb JA, and 1 type II JA. None of the IAs were diagnosed antenatally. There were 2 deaths, both in patients with high JAs with less than 10 cm viable bowel. Only 1 of these was antenatally diagnosed. The median (range) times to full enteral feeding were 20 days (17-22) for antenatally-diagnosed JA, 14 days (11-26) for other JAs, and 8 days (6-15) for IAs. Antenatal diagnosis of SIA thus remains relatively infrequent (less than one-third of cases). When an antenatal diagnosis is made, the atresia is more likely to be proximal in location, requiring intensive and prolonged postnatal treatment. Provided a reasonable length of bowel remains, the outcome of SIA, whether antenatally diagnosed or not, is favorable.

Female↗
PubMed1999

Apple-peel intestinal atresia associated with balanced reciprocal translocation t(2;3)(q31.3;p24.2) mat.

Apple peel intestinal atresia is an apple-peel-appearing bowel obstruction of unknown cause. We describe a Japanese girl with the apple-peel jejunal atresia associated with apparently balanced reciprocal translocation between chromosomes 2 and 3, t(2;3)(q31. 3;p24.2)mat. The translocation breakpoints in the patient may become candidate regions for the putative gene causing apple-peel atresia. Alternatively, the association of the two abnormalities in the patient is coincidental because her phenotypically normal mother had the same chromosome translocation.

Chromosome Banding↗
PubMed1991

[Multiple intestinal atresia with involvement of the entire gastrointestinal tract].

Two new cases with familiar multiple intestinal atresia (MIA) are reported. Two consecutive siblings with MIA were referred to our pediatric surgical unit over the last year. The second child was diagnosed by means of a pre-delivery conducted ecography in the 28 week of pregnancy. In both cases an abdominal x-ray performed just after the delivery, proved the diagnosis of the first obstruction and suggested the MIA diagnosis. The treatment was surgical, fast; the child was operated on in his twenty four hours of life. The macroscopic malformations as well as the histological findings confirmed the MIA diagnosis, that is different from the classical pattern of MIA, called non hereditary. Therefore we can conclude that the familiar MIA with a possible hereditary pattern is grave enough to be recommended the need of an adequate genetic advice and in the future an intestinal transplant.

Digestive System Abnormalities↗
PubMed1989

Management of intestinal atresia complicating gastroschisis.

In a personal series of 22 patients referred with gastroschisis, five (23%) had intestinal atresia. The records of these patients seen over the past 12 years have been studied in order to elucidate the correct management of their complex problems. The indications for primary anastomosis or stoma formation probably depend upon the degree of damage and dilatation of the preatretic intestine at its initial presentation. In patients with a high jejunal or proximal ileal atresia, primary anastomosis should be attempted, but if the dilatation is severe, intestinal decompression may be required. In patients with distal ileal or colonic atresias, the establishment of a stoma and secondary closure is the treatment of choice.

Abdominal Muscles↗
PubMed1993

[Fetal nutrition in intestinal atresia. Studies on the chick embryo].

This paper examines the effects of experimental prenatal intestinal obstruction on the growth and blood composition of chick embryos. Intestinal atresia (IA) was produced by bipolar bowel electrocoagulation in fertile eggs on the 14th day of incubation. The chicks sacrificed on the 19th day were measured, weighed and blood-sampled. Twenty-three control, 10 sham-operated and 11 IA chicks were studied. Animals with IA were severely undernourished by weight (43.4 +/- 4.7 vs 70.3 +/- 7.6% of egg weight, p < 0.001) and length (15.3 +/- 1.1 vs 18.1 +/- 9 mm. tibial length, p < 0.001) in comparison with sham-operated ones. Their haematocrit was slightly lower, and total protein increased. Pre-albumin was absent in their sera and albumin, alpha and beta globulins were significantly decreased whereas gamma-globulin was greatly increased. Sodium, potassium chloride, urea and glucose remained within normal limits. The lack of placenta in the avian embryo precludes any supply of nutrients by this route and the ingestion of amniotic fluid, which is protein-rich after the 13th day of incubation, when the opening of the sero-amniotic connection allows albumen to be mixed with it, becomes the main source of nutrients until hatching. Obstruction of the main incoming avenue by IA induces severe malnutrition in this model which relies on this route to a greater extent than the human foetus. In spite of the obvious biological differences between the avian embryo and the human foetus, the present evidence supports the hypothesis that prenatal interruption of the amniotic fluid transit contributes to foetal undergrowth in IA.

Animals↗
PubMed2001

Natural history of experimental intestinal atresia: morphologic and ultrastructural study.

PURPOSE: The aim of this study was to evaluate a natural history of congenital intestinal atresia (IA) in the chick embryo and to assess the type and nature of changes in the intestine at various developmental stages. METHODS: Chick embryos underwent operative induction of IA on the 12th day of incubation. The procedure consisted of electrocoagulation of the mesenteric vessels supplying a 7- to 8-mm intestinal segment. The embryos were subjected to macroscopic examination, histologic and ultrastructural studies of the preatretic and postatretic bowel using the light microscope, scanning, and transmission electron microscopes. All investigations were performed in an experimental group (operated embryos), in a control group, and in a sham-operated group on the 15th, 17th, 19th, and 21st day of incubation. RESULTS: The original technique of an iatrogenic "vascular event" proved to be effective because IA developed in 96% of embryos surviving the procedure. The affected portion of the bowel underwent progressive necrosis, and signs of bowel obstruction could be observed 48 hours after operation. Cord atresia (type II) developed in 81% of embryos. Histologic investigations showed progressive thinning of mucosa, flattening of mucosal folds, and epithelial detachment within the intestine proximal to atresia. There was only mild hypertrophy of the muscular layers. All these pathomorphologic changes were of rapidly progressive nature until the 17th day of incubation. Later, the rate of distension of preatretic bowel and histologic changes were less. Ultrastructural investigation of the proximal bowel showed progressive flattening of the enterocytes associated with their apical bulging, widening of the intercellular spaces, and microvilli atrophy. Surprisingly, at days 19 and 21 of incubation, signs of induction of adaptive mechanisms with partial restoration of near-normal microvilli pattern were observed. CONCLUSIONS: Study of natural history of experimental IA indicates that histologic and ultrastructural lesions of the bowel are of dynamic nature and are not only the effect of pathologic intraluminal pressure.

Animals↗
PubMed1975

Intestinal atresia in fetal dogs produced by localized ligation of mesenteric vessels.

Experimental ileal atresia and stenosis were produced by a localized ligation of the mesenteric vessels in fetuses from 13 pregnant mongrel dogs having gestational ages of 45-55 days. The intestinal infarct in the fetus was characterized by an aseptic coagulation necrosis selectively limited to the mucosa and submucosa, and also by intense hyperemia and minimal cellular reaction in the adjacent tissue. Eleven days after the devascularization, type 2 intestinal atresia, in which there is a long cord between the blunt ends microscopically similar to that seen in humans.

Animals↗
PubMed1992

The nutrition of the fetus with intestinal atresia: studies in the chick embryo model.

This article examines the effects of experimental prenatal intestinal obstruction on the growth and blood composition of chick embryos. Intestinal atresia (IA) was produced by bipolar bowel electrocoagulation in fertile eggs on the 14th day of incubation. The chicks killed on the 19th day were measured, weighed, and blood-sampled. Twenty-three control, 10 sham-operated, and 11 IA chicks were studied. Animals with IA were severely undernourished by weight (43.4 +/- 4.7 v 70.3 +/- 7.6% of egg weight, P < .001) and length (15.3 +/- 1.1 v 18.1 +/- 0.9 mm tibial length, P < .001) in comparison with sham-operated ones. Their hematocrit was slightly lower, and total protein increased. Prealbumin was absent in their sera and albumin, alpha and beta globulins were significantly decreased, whereas gamma-globulin was greatly increased. Sodium, potassium chloride, urea, and glucose remained within normal limits. The lack of placenta in the avian embryo precludes any supply of nutrients by this route and the ingestion of amniotic fluid, which is protein-rich after the 13th day of incubation, when the opening of the seroamniotic connection allows albumen to be mixed with it, becomes the main source of nutrients until hatching. Obstruction of the main incoming avenue by IA induces severe malnutrition in this model which relies on this route to a greater extent than the human fetus. In spite of the obvious biological differences between the avian embryo and the human fetus, the present evidence supports the hypothesis that prenatal interruption of the amniotic fluid transit contributes to fetal undergrowth in IA.

Amniotic Fluid↗
PubMed1994

Small intestinal atresia: effect on fetal nutrition.

The peak velocity for fetal weight gain occurs in the last few weeks of pregnancy. As the fetus matures, it swallows and absorbs an increasing amount of amniotic fluid, which contributes to the growth of the fetus. The authors studied cases of small intestinal atresia (IA) treated over 9 years to determine whether amniotic fluid has any nutritive role in the development of human fetus, and if it does, at what stage of gestation is the contribution of amniotic fluid significant to fetal nutrition. Fifty-nine newborns had IA (24 jejunal, 35 ileal). Ten of the patients had associated anomalies (3 cystic fibrosis, 2 congenital heart disease, 1 neural tube defect, 1 microcephaly, 2 malrotation, 1 vesicoureteric reflux). Among the 24 babies with jejunal atresia, one was a twin, and birth weight was not recorded for another. These two patients were excluded from the study. Of the remaining 22 patients with jejunal atresia, 10 were born before 36 weeks' gestation; only five of 35 patients with ileal atresia were born before 36 weeks' gestation. Fourteen patients were below the 10th percentile for birth weight after correction for gestational age, one was born before 36 weeks, and 13 were born after 36 weeks. Five (41.7%) of the 12 patients with jejunal atresia who were born after 36 weeks' gestation were underweight, as were eight (26.7%) of the 30 patients with ileal atresia. Thus, it appears that amniotic fluid contributes to the fetal growth in the last few weeks of gestation, and the higher the obstruction in the small intestine, the more pronounced the effect on the nutrition of the fetus.

Amniotic Fluid↗
PubMed1993

[Intestinal atresia: what is changed in the last 30 years].

The changes occurred in the management of intestinal atresia in the last 30 years are presented. On the basis of a series of 55 neonates (29 M/26 F; 14 premature; mean body weight 2640 g, range 1340-4100 g; 23 duodenal, 30 small bowel, 2 colon) four aspects of this malformation are discussed; epidemiology, diagnostics, therapy and prognosis. Epidemiology. 40% incidence reduction is detected; unchanged the relative incidence of Down neonates with duodenal atresia. Diagnostics. Prenatal US scan useful in 4 of 8 cases only; emphasized the usefulness of plain X-ray abdomen. Perioperative treatment. Dramatic impact of the artificial nutrition on the management of short bowel syndrome, with 7 cases (residual small bowel from 75 to 9 cm, mean 40 cm) successfully treated. Surgical technique. Confirmed the validity of the one-stage termino-terminal anastomosis. Prognosis. Significant improvement in the last three decades respectively with 50%, 87% and 93% of long-term survivors. In the first decade 6 over 8 deaths were related to the atresia, while in the last 10 years the only death recorded was related to an associated severe cardiac malformation.

Anastomosis, Surgical↗