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UNLABELLED: Intrauterine intussusception is one of the rare causes of intestinal atresia. CONCLUSION: A case of ileal atresia due to intrauterine intussusception caused by Meckel's diverticulum is reported.
This study was designed to investigate the motility of the small bowel of the lamb under the conditions of experimental intestinal atresia. Of 26 fetal lambs operated upon (50 to 90 days gestation), 13 came to term. All term lambs exhibited a type 3a atresia. Six were successfully repaired and had intestinal myoelectric activity monitored for periods from 2 to 27 hours. A slow wave pattern (12 to 13/min) was present in the bowel of control lambs and in the proximal dilated bowel and the microbowel of atretic lambs, confirming the presence of functional smooth muscle. Spike potentials, which indicated circular muscular contractions, occurred 10% of the time in the control intestine, 5% in the proximal dilated gut (P less than .2), and 0% in the microbowel (P less than .001). A previously undescribed myoelectric transient of variable amplitude and frequency (6 to 24/min) was identified in all lambs studied. Histologic evaluation demonstrated villous hyperplasia in the microbowel and mucosal flattening in the distended bowel. The data suggest that the quiescent microbowel distal to the atresia contributes significantly to the functional obstruction.
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Neonates with multiple sites of intestinal atresia (MIA) may be predisposed to short-gut syndrome. Anastomoses of the intervening segments may prevent this complication. 5 neonates with MIA, one of them with a gastroschisis, were operated on: a proximal enterostomy was constructed, a side-to-end anastomosis as described by Santulli and several end-to-end anastomoses between the intervening intestinal segments (n = 3 to 7) were performed. An additional infant, initially operated on for a necrotizing enterocolitis (NEC) was managed with the same surgical procedure. Without use of this technique, the remaining length of small intestine would have been 28, 27, 40, 58, 70 and 7 cm. This technique enabled an intestinal length of 49, 54, 96, 107, 92 and 93 cm respectively to be achieved. Ileocecal valve was present in all 5 cases with MIA, but resected in the case with NEC. The enterostomy was reversed 7 weeks later. The initial outcome (delay of enteral feeding, duration of parenteral nutrition) was good: the babies were weaned from parenteral nutrition (PN) after a mean time of 90 days (48 to 163 days). The prognosis (mean follow-up: 31 months, range 14 to 57) was good with regards to growth and development and length of time required before adaptation to normal enteral feedings and stools. This surgical method allows complete decompression of the proximal jejunum so that nutriment can pass into the distal bowel allowing it to enlarge. In cases of MIA, a long tapering proximal enteroplasty is a better procedure than resecting more than 5-10 cm of the proximal distended and hypertrophied bowel. We prefer to perform an enterostomy in association with multiple anastomoses between intervening intestinal segments. The enterostomy is preserved for long enough waiting period to enable the reversion of the histochemical and morphological changes that may have taken place in the bowel.
Prenatal diagnosis performed by fetal ultrasound scan is now a routine part of antenatal care in many countries. That an increasing number of fetal anomalies may be detected on prenatal ultrasound is beyond doubt. However what is theoretically possible is not, always done in practice specially when gastrointestinal atresias (GIA) are concerned and when whole antenatal populations are screened rather than high risk groups. Thanks to our registry of congenital anomalies a retrospective study was undertaken to evaluate the prenatal detection of GIA by ultrasound scan in 118,265 consecutive pregnancies of known outcome. Only 31 out of 129 malformed fetuses with GIA were detected (24.0%). The sensitivity of detection varied from 51.4% for atresia of the small intestine to 24.2% for esophageal atresia and 8.2% for ano-rectal atresia. No isolated case with esophageal atresia and ano-rectal atresia were diagnosed. Our results stress the need to perform scans at > or = 18 weeks gestation and to train sonographers in order to improve prenatal detection of GIA.
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Aiming at depicting the advantages of chick embryo as a model of fetal surgery we report on our experience of 402 operations carried out in an attempt to induce fetal intestinal obstruction. We have used fertile domestic hen (gallus gallus) eggs incubated at 37.5 degrees with 80% humidity and turned every hour. At the 12th day of incubation we coagulated, after exposing the umbilical cord, a small bowel loop in the physiologic umbilical hernia through a 1 cm-wide opening in the shell which was then sealed with plastic sterile adhesive. After sacrifice at the 15th day of the 76 surviving embryos (19%) we found type I intestinal atresia with localized meconium peritonitis and dilated proximal loop in 46 cases. In 3 out of them there was, like in some human newborns with intestinal obstruction, increased amount of bile-stained amniotic fluid. Both macroscopic and microscopic findings were identical to those usually found in human atresia and in that experimentally induced in fetus of other animal species. We firmly believe that our model is as good as any other for this purpose and, at the same time, it is cheaper and easier to handle.