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Intestinal atresia
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Neonatal intestinal atresia, a cause of bowel obstruction, has a 90% survival rate. Management of short bowel syndrome, a complication, is improving with new feeding strategies and potential growth factor therapies.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastroenterology
Background:
- Intestinal atresia is a significant cause of neonatal intestinal obstruction, representing about one-third of cases.
- Survival rates for intestinal atresia have improved to 90%, with operative mortality below 1%.
Purpose of the Study:
- To review the current understanding of intestinal atresia, including its causes, diagnostic challenges, and management strategies.
- To highlight the impact of associated conditions and the challenges posed by short bowel syndrome.
Main Methods:
- Review of existing literature on intestinal atresia, focusing on survival rates, mortality factors, diagnostic accuracy of prenatal ultrasonography, and management of short bowel syndrome.
- Analysis of factors influencing mortality, such as multiple atresias, apple peel atresia, and associated conditions like meconium ileus and gastroschisis.
Main Results:
- Survival rates vary significantly with specific types of atresia and associated conditions, with multiple atresias and apple peel atresia having higher mortality.
- Prenatal ultrasonography shows suggestive signs of gastrointestinal issues but has limited confirmation rates; it is more reliable for duodenal atresia.
- Short bowel syndrome remains a primary challenge, and while total parenteral nutrition (TPN) is standard, it can delay adaptation and cause complications.
Conclusions:
- While survival for intestinal atresia is high, associated conditions and short bowel syndrome present ongoing management difficulties.
- Emerging strategies like graduated enteric feedings, growth factors, and potential small bowel transplantation offer promise for improving long-term outcomes in patients with short bowel syndrome.
Abstract:
Intestinal atresia accounts for about one third of all cases of neonatal intestinal obstruction. The survival rate has improved to 90% in most of the series with the operative mortality being < 1%. The survival rate improves with distal atresias. An increased mortality is observed in multiple atresias (57%), apple peel atresia (71%), and when atresia is associated with meconium ileus (65%), meconium peritonitis (50%) and gastroschisis (66%). Although appearance of echogenic bowel on prenatal ultrasonography is suggestive of GI, it is confirmed in only 27% cases. Prenatal ultrasonography is more reliable in detection of duodenal atresia than more distal lesions. Short bowel syndrome is the major impediment in the management of jejunoileal atresia. Although total parenteral nutrition (TPN) is the main adjunctive treatment, it delays intestinal adaptation and may cause cholestasia and subsequent liver damage. Graduated enteric feedings, use of growth hormone, glutamine and modified diets containing low fat, complex carbohydrates and protein supplements have been used in a adults with short bowel syndrome to successfully diminish TPN requirements and enhance nutrient absorption in nearly half of the patients. Utilization of growth factors to facilitate intestinal adaptation and advances in small bowel transplant may improve the long-term outcomes in future.