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JEJUNOILEAL ATRESIA IN THE NEWBORN
Category: Child Health
Abstract : jejunoileal atresia in the newborn : Atresia of the jejunum or ileum is more
common than duodenal atresia, occurring in 1 in 1500 births. Small-bowel
obstruction from jejunoileal atresia may also lead to polyhydramnios. Premature
delivery is observed in one third of patients with intestinal atresia. In
contrast to duodenal atresia, jejunoileal atresia is widely considered to be a
cond
jejunoileal atresia in the newborn :
Atresia of the jejunum or ileum is more
common than duodenal atresia, occurring in 1 in 1500 births. Small-bowel
obstruction from jejunoileal atresia may also lead to polyhydramnios. Premature
delivery is observed in one third of patients with intestinal atresia.
In
contrast to duodenal atresia, jejunoileal atresia is widely considered to be a
condition acquired during development, rather than a preprogrammed anomaly. In
classic work on fetal dogs in 1955, Louw and Barnard demonstrated the
pathophysiology by which intrauterine mesenteric vascular accidents produce
atresia in the segment of intestine that is devascularized.
The extent of
atresia and the appearance of the atretic intestinal segment vary according to
the timing and degree of the disruption of the mesenteric blood supply. Atresias
may be focal or multiple throughout the small bowel. Interruption of the main
superior mesenteric blood supply can result in atresia of most of the jejunum
and ileum. Other abdominal conditions, such as gastroschisis or intrauterine
intussusception, may be associated with intestinal atresia, presumably from
kinking, stretching, or otherwise disrupting the blood supply to the fetal
bowel.
Chromosomal anomalies are rare (<1%) in children with
jejunoileal atresia. Infants with jejunoileal atresia may present with
distention and vomiting. Thumb-sized loops of bowel with air-fluid levels can be
observed on plain radiography. As many as 12% of newborns with jejunoileal
atresia may have intra-abdominal calcifications observed on plain radiography.
These calcifications are consistent with meconium peritonitis, resulting from
necrosis and perforation of a devascularized loop of bowel. Blood flow to the
segments immediately proximal and distal to the atresia may be compromised. For
this reason, preoperative nasogastric decompression is vital to limit distention
of the intestine proximal to the atresia. A delay in diagnosis or operation may
distend and compromise the poorly vascularized, dilated, often bulbous
bowel.
Some surgeons insist on a contrast enema to exclude colonic
atresia, while others examine the colon intraoperatively to ensure patency of
the distal bowel. Surgery for jejunoileal atresia involves resection and primary
anastomosis of the atretic segments. Diverting ostomies are avoided if possible.
As with surgery for duodenal atresia, tapering of the proximal dilated segment
occasionally is necessary to limit the motility problems observed with dilated
proximal bowel. If at all possible, the ileocecal valve is preserved. Long-term
outcomes are generally excellent if sufficient bowel is present for absorption
and growth.
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