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Intestinal atresia and stenosis: analysis of survival in 120 cases
Insights
Infants with intestinal atresia and stenosis have high survival rates, with surgical interventions improving outcomes. However, severe associated anomalies and complications from total parenteral nutrition remain critical challenges.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Intestinal atresia and stenosis are congenital conditions affecting newborns.
- These conditions necessitate prompt surgical intervention for survival.
Purpose of the Study:
- To review the clinical presentation, operative management, and survival rates of infants with intestinal atresia and stenosis.
- To identify factors influencing outcomes and causes of mortality.
Main Methods:
- Retrospective review of 120 infants treated between 1972 and 1984.
- Analysis of surgical procedures, associated anomalies, and nutritional support (total parenteral nutrition).
Main Results:
- High survival rates: 91% for duodenal, 87% for jejunoileal, and 100% for colonic defects.
- Severe associated anomalies were a primary cause of death in duodenal atresia.
- Sepsis and liver failure from total parenteral nutrition complicated jejunoileal atresia cases.
Conclusions:
- Surgical management of intestinal atresia and stenosis yields favorable survival rates.
- Addressing severe associated anomalies and optimizing nutritional support are crucial for improving outcomes in complex cases.
Abstract:
This report reviews the clinical presentation, operative management, and survival in 120 infants with intestinal atresia and stenosis treated from 1972 to 1984. Duodenal atresia occurred in 39 neonates and duodenal stenosis in 19. Thirty-two infants had severe associated anomalies. Operative management included duodenoduodenostomy in 47 infants, duodenotomy and web excision in four, and duodenojejunostomy in seven. Jejunoileal atresia occurred in 49 infants and stenosis in three. Six infants had cystic fibrosis and nine had gastroschisis. Operative therapy included wide proximal resection and end-to-end anastomosis in 18 infants, minimal resection with antimesenteric tapering enteroplasty and anastomosis in 14 neonates, and resection with temporary enterostomies in 20 infants. Twenty-nine infants (56%) required total parenteral nutrition. Colon atresia occurred in 11 infants and stenosis in one. Initial end-colostomy with subsequent resection and anastomosis was performed in 11 infants while one underwent a primary resection. The survival rate was 91% for duodenal defects, 87% for jejunoileal cases, and 100% for colonic anomalies. Death is currently caused by severe associated anomalies in infants with duodenal atresia and sepsis and total parenteral nutrition-related cholestasis with progressive liver failure in instances of jejunoileal atresia.