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At least 19 recordsLinked to original sources
PubMed1977

Gastroschisis complicated by intestinal atresia.

Gastroschisis complicated by intestinal atresia is a complex problem. Six cases are presented. A review of the literature and of our own cases shows a high mortality rate. Success or failure is related more to the pathology present than to any specific method of operative management. Resection and primary anastomosis is the favored method of treatment, as the intestine heals well in spite of its appearance. Primary closure of the abdominal wall musculature and skin is done whenever possible. A gastrostomy is used uniformly. Intravenous hyperalimentation is critical to survival of these babies and should be used early. The use of this therapeutic modality allows for the onset of gastrointestinal function spontaneously (often over prolonged periods of time) without nutritional deprivation. Intestinal atresias almost always are easy to identify in babies with gastroschisis. Extensive dissection and mobilization of this friable intestine is contraindicated in those babies in whom an atresia is not obvious but only suspected. In such cases the gastroschisis defect should be managed by whatever method is deemed appropriate and the baby observed while receiving intravenous nutritional support. If an atresia is present, it can be managed later in the baby's course by resection and primary anastomosis.

Abdominal Muscles↗
PubMed1990

Congenital intestinal atresia.

Surgery for infants with intestinal atresia has evolved along with the development of specialized neonatal surgical units. This once fatal condition now carries a better than 85% chance of survival and an excellent long-term prognosis. Recent advances in bowel preservation techniques have reduced morbidity and improved gut function in both the long and the short term.

Anastomosis, Surgical↗
PubMed1975

The pathogenesis of intestinal atresia.

The records of 28 patients with duodenal and 31 with jejunoileal intestinal atresia or stenosis were studied. Vomiting and abdominal distention were the most prominent symptoms; an unusual colon may be present in jejunal as well as ileal obstruction and is not pathognomonic for ileal obstruction. Intestinal atresia is associated with a high incidence of preterm babies but with a low incidence of intrauterine growth retardation. Fifty-three infants were operated upon; the overall survival rate was 79 per cent. The high percentage of mortality in duodenal obstruction is due to associated malformations. Theories of the pathogenesis of intestinal atresia do not seem to fit current clinical and experimental evidence in all patients. Possibly, different factors play a role in separate situations.

Abnormalities, Multiple↗
PubMed1991

Umbilical cord ulceration and intestinal atresia: a new association?

In three fetuses, congenital intestinal atresia was associated with linear ulcerations of the umbilical cord. In two cases, hemorrhage was seen from the cord ulcer. Both fetuses required emergency cesarean section for fetal distress and were born anemic. The third fetus was mildly hydropic, attributed to hemorrhage, and was stillborn. The mechanism of the association could not be determined. These cases suggest a risk of prenatal umbilical cord hemorrhage in infants with intestinal atresia.

Adult↗
PubMed1978

Intestinal atresia.

Forty-five patients with intestinal atresia, including 20 with duodenal, 21 with jejunoileal, and 3 with colonic obstruction, were encountered at the Yale-New Haven Hospital between 1970 and 1976. The overall survival rate in the 43 operated cases was 93 per cent. The major reasons for the excellent operative survival with this malformation include: (1) the care received in a regional neonatal center; (2) the early recognition and appropriate case selection, denying operation unless mandated in babies with duodenal atresia and trisomy 21; (3) primary repair using modern surgical techniques which minimize anastomotic complications and the "blind-loop" and "short gut syndrome"; and (4) the use of uncomplicated long-term total parenteral nutrition in approximately one-half of operated cases.

Abnormalities, Multiple↗
PubMed1979

Complicated intestinal atresias.

In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction.

Abnormalities, Multiple↗
PubMed1991

Gastroschisis and intestinal atresia.

Controversy exists over the best method of treating gastroschisis with concomitant intestinal atresia because the mortality in such patients is still high. We present our experience of 74 neonates with gastroschisis seen over a 17-year period. Four patients (5.5%) had intestinal atresia; 1 had only one small bowel atresia, 2 had double areas of atresia (one in the mid small bowel and the other in the proximal colon), and the remaining 1 had multiple areas of atresia. Atresia with gastroschisis conventionally has been treated by either primary anastmosis or by exteriorization. Three of the patients were treated by replacing the atretic bowel into the abdomen initially and exploring later (1 to 3 weeks) when the bowel appeared much more healthy, making the anastomosis easier and more secure. One patient with extreme jejunal dilatation was treated by creation of a Mikulicz fistula. All 4 of the patients survived the newborn period, but one of them died at 1 year of age due to total parenteral nutrition-induced chronic liver failure. Our experience is presented to emphasize this uncommonly used approach to this complex problem because it seems to be associated with a lower morbidity and mortality than other conventional approaches.

Abdominal Muscles↗
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↗
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↗
PubMedDate not supplied

[Intestinal atresia].

The authors reviewed their experience with 20 cases of intestinal atresia (jejunum, ileum and colon) admitted between January 1972 and January 1977. International literature shows 80% mortality rate for this malformation before 1940 and 10-25% in current reports. In Mexico, before 1959, the mortality rate was 80%, but the most recent reports showed 28% mortality rate for atresia and 33% in cases of stenosis. The group of patient studied included twelve cases with a weight over 2,500 g. and eight patients under 2,500 g. Four patients showed multiple associated malformations (incompatible with life in one case) and in 17, there were no associated malformations. Nineteen cases were operated, the dilated and atresic segments were resected and anastomosis was performed. It was termino-terminal in 13 cases and termino-lateral in 6. One case was explored surgically and no attempt to repair the atresias was made, because there were malformations incompatible with life. Four patients died. Even if this series is very small, the associated malformations, low weight and techniques used do not seem to influence the prognosis of these patients.

Female↗
PubMedDate not supplied

[Surgical management of intestinal atresia].

The study included 33 newborns with the diagnosis of intestinal atresia after discarding those of the duodenum. According to the clinical conditions of the patient and of the malformation, surgery was carried out by derivative ileostomy or primary anastomosis. Survivorship reaches 67% for ileostomy and 65% for anastomosis which are much higher figures than those obtained before.

Female↗
PubMed1991

Mucosal morphology in experimental intestinal atresia: studies in the chick embryo.

Lesions identical to those observed in human intestinal atresia (IA) have been experimentally reproduced in several mammal models by either mesenteric vessels or intestinal wall injury. The recent availability of an avian model led us to investigate whether the same lesions could be studied at less expense. An intestinal loop within the body stalk hernia was coagulated on the 12th incubation day in 427 chick embryos (group 3), the lesions were studied in survivors 4 days later under light and scanning electronmicroscopy (EM), and the findings were compared with those in 12 control embryos (group 1) and 14 sham-operated ones (group 2). Types I or II atresias were obtained in 61 (73.4%) of the 83 survivors in group 3. Seromuscular layers were normal at both ends of the lesion; there was some flattening of villi at the proximal, dilated end, and hyperplasia with apparently lengthened, branched villi at the distal, unused one. Mucosal pattern under light microscopy was strikingly close to that observed in human IA and in the fetal lamb experimental model. On the other hand, scanning EM showed that in this model there were no villi as such, but rather prominent mucosal folds that were regularly arranged in a tire-rubber pattern in the normal intestine, flattened and distended in the dilated one, and again roughly normal in the distal unused gut. High-power magnification scanning EM showed that enterocytes were normal at all levels but, in agreement with previous findings in the fetal lamb model, that intercellular spaces were widened in the dilated portion adjacent to the obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1976

Duodenojejunal atresia with "apple-peel" small bowel. A distinct form of intestinal atresia.

Prenatal occlusion of the superior mesenteric artery results in a distinct type of distal duodenal or proximal jejunal atresia in which the dorsal mesentery is absent and the distal small bowel assumes a spiral configuration around its vascular stalk, strongly resembling an apple peel. In some instances the condition is transmitted genetically as an autosomal recessive disorder. The mortality rate is much higher than in either simple duodenal or jejunal atresia because of deficient collateral circulation to the small intestine. The authors tell of 2 patients who died of necrotizing enterocolitis, a disease related to vascular insufficiency.

Duodenum↗
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↗
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↗