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Pediatric Surgery
Intestinal atresias are the product of a late intrauterine mesenteric vascular
accident (blood supply was not received by a portion of bowel) as attested by
Louw and Barnard in 1955. They are equally distributed from the ligament of
Treitz to the ileocecal junction. Colonic atresias are very rare. There is
proximal bowel dilatation, with distal (unused) micro-bowel. The diagnosis is
suspected with maternal history of polyhydramnios (the higher the atresia),
bilious vomiting, abdominal distension and obstipation. KUB shows “thumb-size”
dilated bowel loops, and barium enema a microcolon of disuse. Louw classified
them into: Type I: an intraluminal diaphragm with seromuscular continuity. Type
II: cord-like segment between the bowel blinds ends. Type IIIA: atresia with
complete separation of blind ends and V-shaped mesenteric defect (see figure),
the most commonly found. Type IIIB: jejunal atresia with extensive mesenteric
defect and distal ileum acquiring its blood supply entirely from a single
ileocolic artery. The distal bowel coils itself around the vessel, giving the
appearance of an "apple peel"deformity. Type IV: multiple atresias of the small
intestine. After preoperative stabilization (GI decompression, electrolytes
disturbances’ correction, antibiotherapy, and normothermia), treatment consists
of exploratory laparotomy, resection of proximal dilated intestine, and end to
oblique anastomosis in distal jejuno-ileal atresias. Tapering jejunoplasty with
anastomosis is preferred in proximal defects.
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