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Diagnosis and treatment of jejunoileal atresia
1Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510.
Insights
Intestinal atresia and stenosis affect newborns, with the duodenum being the most common site. Surgical correction offers a high survival rate, aided by advances in prenatal diagnosis and neonatal care.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Malformations
Background:
- Intestinal atresia and stenosis are congenital conditions requiring surgical intervention.
- A significant number of cases are diagnosed and treated in specialized neonatal units.
Purpose of the Study:
- To review the incidence, management, and outcomes of intestinal atresia or stenosis.
- To identify factors contributing to improved survival rates in affected neonates.
Main Methods:
- Retrospective analysis of 116 cases of intestinal atresia/stenosis treated between 1970 and 1990.
- Review of surgical interventions, complications, and survival rates.
- Analysis of specific challenging cases, including apple-peel atresia and short-gut syndrome.
Main Results:
- The duodenum was the most frequently affected site (53%), followed by the jejunum/ileum (46%) and colon (7%).
- An overall survival rate of 92% was achieved following operative correction.
- Management of complex cases like apple-peel atresia and short-gut syndrome presented significant challenges.
Conclusions:
- Improved outcomes in intestinal atresia are attributed to prenatal diagnosis, regionalized neonatal care, and advanced surgical techniques.
- Long-term total parenteral nutrition plays a crucial role in managing patients with short-gut syndrome.
- Continued advancements in neonatal care and surgical innovation are vital for improving survival and quality of life for infants with intestinal atresia.
Abstract:
A total of 116 cases of intestinal atresia or stenosis were encountered at the Yale-New Haven Hospital between 1970 and 1990. Sites involved were the duodenum (n = 61; 53%), jejunum or ileum (n = 47; 46%), and colon (n = 8; 7%). All but two patients underwent operative correction, for an overall survival rate of 92%. Challenging problems were the management of apple-peel atresia (five patients), multiple intestinal atresia with short-gut syndrome (eight patients), and proximal jejunal atresia with megaduodenum requiring imbrication duodenoplasty (four patients). Major assets in the improved outlook for intestinal atresia are prenatal diagnosis, regionalization of neonatal care, improved recognition of associated conditions, innovative surgical methods, and uncomplicated long-term total parenteral nutrition.