Individualized management of colonic atresia

Pohlson, Elizabeth C.; Hatch, Edwin I.; Glick, Philip L.; Tapper, David

doi:10.1016/s0002-9610(88)80146-6

Cited by 34 publications

(28 citation statements)

References 13 publications

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“…Atresia of the colon is a relatively rare form of intestinal atresia [2] with an incidence of 1:40,000 to 1:60,000 live births [3,4] and comprises less than 10% of the total number of gastrointestinal tract atresias [5,6] (4.4% in our series). The aetiology of colonic atresia remains a subject of much debate and research with various theories being advanced.…”

Section: Discussionmentioning

confidence: 98%

“…Aetiology of this injury has been the subject of fetal research and clinical observations, with volvulus, pinching of intestine at its mesentery or at the fetal umbilical ring, intussusception, focal perforation from local inflammation and interference with mesenteric blood supply being put forward as possible causes [2,10]. All four types of atresias have been reproduced experimentally in the small bowel of animals by ligating fetal mesenteric vessels [5,7].…”

Section: Discussionmentioning

confidence: 99%

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Colonic atresia: spectrum of presentation and pitfalls in management. A review of 14 cases

Numanoglu

Millar

et al. 2005

Ped Surgery Int

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Fourteen cases of colonic atresia seen over a 38-year period are reviewed with particular reference to clinical presentation and pitfalls in management. Seven had Type I atresia, two Type II and five Type IIIa. Ten had associated gastrointestinal anomalies. Management varied considerably. Six had primary colonic anastomosis. Two of these developed complications due to unrecognized distal hypoganglionosis, two had associated jejunal atresias resulting in short bowel syndrome, and two had primary anastomosis protected by proximal ileostomies. Seven had a staged repair with initial defunctioning enterostomy with only one complication, an unfixed mesentery that later resulted in midgut volvulus. The only mortality was a patient in which a jejunal atresia repair leaked as a result of a missed colonic atresia. Operative strategy should depend on the clinical state of the patients, the level of atresia, associated small bowel pathology and exclusion of distal pathology. Primary anastomosis would only rarely be advised with a circumspect approach. Long-term outlook, as in small bowel atresia is generally excellent.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Colonic atresia: spectrum of presentation and pitfalls in management. A review of 14 cases

Numanoglu

Millar

et al. 2005

Ped Surgery Int

View full text Add to dashboard Cite

show abstract

“…However, primary anastomosis may be technically difficult because of the very large difference between the sizes of the distal and proximal bowels, and the loss of length associated with resection of dilated proximal colon [26]. Many authors have reported the resection and primary anastomosis as a reasonable treatment option regardless of the location of colonic atresia , if the newborn's condition allows it [27]. Patency of the distal colon segment should be tested by retrograde or antegrade instillation of air and saline.…”

Section: Discussionmentioning

confidence: 99%

“…Further management recommendations vary widely, proximal colostomy is well tolerated in infants and delayed reestablishment of intestinal continuity can be done later. The proximal and distal colonic ends adjacent to the atresia are abnormal in both innervation and vascularisation, that's why in addition to resecting the bulbous proximal end, a portion of the microcolon should also be resected [27].…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of small bowel atresia, the normal length of small intestine should allow normal bowel function [2,25]. If colonic atresia diagnosed early and if other major pathologies are absent, overall mortality should be 10% or less [27], early diagnosed and individually treated isolated cases of colonic atresia are not likely to have an unfavorable prognosis. Significant high mortality rates in cases operated after 72 hours seem to underline the importance of early diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

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