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[What can we do to improve our management of intestinal atresia?]
R Delgado Alvira1, A González Esgueda, B Estors Sastre
1Servicio de Cirugía Pediátrica, Hospital Infantil Universitario Miguel Servet, Zaragoza. reyesdelgado@yahoo.es
Insights
Intestinal atresia (AI) management shows duodenal atresia-stenosis (AD) has higher mortality due to heart disease, while jejunoileal atresia (AYI) requires frequent reoperations for obstructions. Prenatal diagnosis remains challenging for both types.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Context:
- Intestinal atresia (AI) is a congenital condition requiring surgical intervention.
- Management strategies and outcomes vary significantly between duodenal atresia-stenosis (AD) and jejunoileal atresia (AYI).
- Prenatal diagnosis of AI presents challenges, impacting early management decisions.
Purpose:
- To review the management of intestinal atresia (AI) cases.
- To analyze surgical outcomes and complications associated with different types of AI.
- To evaluate the effectiveness of prenatal diagnosis in AI management.
Summary:
- A retrospective review of 41 intestinal atresia (AI) patients from 1995-2011.
- Duodenal atresia-stenosis (AD) cases (21) had better surgical response but higher mortality (57% with heart disease).
- Jejunoileal atresia (AYI) cases (20) required frequent reoperations (45%) for obstructions and complications, with lower mortality but longer parenteral nutrition (29 days) and hospital stays (37.3 days).
Impact:
- Highlights the need for improved prenatal diagnostic methods, especially for AYI (35% prenatal diagnosis).
- Underscores the distinct surgical challenges and outcomes for AD versus AYI.
- Emphasizes the importance of considering colorectal atresias, which are often unidentified.
Objective:
To review our management of intestinal atresia (AI).
Material And Methods:
A retrospective review of patientes with AI, from 1995 to 2011.
Results:
AI was identified in 41 patients, 29,2% had maternal polyhydramnios and 48,7% were diagnosed prenatally. Four of them had Down Syndrome and 18 had cardiopathy. Duodenal atresia-stenosis (AD) was present in 21 patients, that were treated by 19 duodenoduodenostomy, 1 duodenojejunostomy and 1 duodenotomy with duodenal membrane resection. Jejunoileal atresia (AYI) was present in 20 patients and we performed 15 end to end anastomosis, 1 íleo-colic anastomosis, 1 ileostomy, 2 jejunostomies and 1 end to end anastomosis with jejunostomy. Nine AYI were reoperated: 6 bowel obstructions, 1 evisceration and 2 colo-rectal atresia. The average time on parenteral nutrition was 29 days and average hospital stay was 37,3 days. One AD died due to heart disease. In AYI, 2 required transfer to another center due to short bowel.
Conclusions:
Prenatal diagnosis of AI is difficult, especially AYI, which is only prenatally diagnosed in 35% of cases. AD respond better to surgery and rarely require reoperation, but mortality is higher than AYI because 57% suffer from heart disease. Reoperations are frecuent in AYI (45% of our patients), usually due to obstruction, ostomy closure and problems resulting from extensive bowel resections. It's important to keep in mind colorectal atresias, which can not be identified.
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