Jejunoileal atresia: A 27-year experience

Sato, Sojun; Nishijima, Eiji; Muraji, Toshihiro; Tsugawa, Chikara; Kimura, Ken

doi:10.1016/s0022-3468(98)90596-6

Cited by 35 publications

(33 citation statements)

References 8 publications

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“…To avoid functional obstruction and abnormal motility in retained proximal bowel, dilated segment can be excised up to ligament of Treitz. Some reports suggest that resection of dilated proximal bowel should be minimized, as TPN can take care of the period of dysmotility and impaired anastomotic function [15]. However preservation of as much bowel length as possible at the risk of creating a poorly functioning anastomosis can produce significant morbidity and mortality [16,17].…”

Section: Discussionmentioning

confidence: 99%

Intestinal Atresia: Experience at a Busy Center of North-West India

Gupta

Ghosh

et al. 2016

J Neonat Surg

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Objective: To evaluate the presentation, management, complications and outcome of intestinal atresia (IA) managed at our center over a period of 1 year.Materials and methods: Records of patients of IA admitted in our center from January 2015 to December 2015 were retrospectively analyzed. Demographic data, antenatal history, presenting complaints, location (duodenal, jejunoileal, colonic) of atresia, surgery performed and peri-operative complications were noted.Results: Total 78 cases of IA were included in the analyses. Mean age and weight at the time of presentation was 5.8 days (range 0-50), and 1.9 kg (range 1.1-3.2), respectively. IA included duodenal atresia [DA (32)], jejuno-ileal atresia [JIA (40)], colonic atresia [CA (3)] and atresia at multiple-location (sites) in 3 cases. Ninety percent of patients underwent surgery within 5 to 20 hours of admission. All cases of DA except one underwent Kimura's diamond shaped duodeno-duodenostomy. One case with perforated duodenal web underwent duodenotomy with excision of web. Seven patients with JIA and CA required primary stoma, while rest were managed by excision of dilated proximal segment and primary anastomosis. Complications included anastomotic leak in 5, proximal perforation in 2, functional obstruction in 7, aspiration pneumonitis in 3, and wound infection in 6 patients. Mean hospital stay for survivors was 11 days. Overall survival was 63%.Conclusion: Late presentation, overcrowding in intensive care unit, septicemia, functional obstruction and anastomotic leak are the causes of poor outcome in our series. Early diagnosis, some modification in surgical technique, use of total parenteral nutrition and adequate investigations for other congenital anomalies may improve the outcome.

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Section: Discussionmentioning

confidence: 99%

Intestinal Atresia: Experience at a Busy Center of North-West India

Gupta

Ghosh

et al. 2016

J Neonat Surg

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“…In recent reports, multiple anastomoses (upto 7 in number) have been advocated by several authors in order to increase the available intestinal length in type IV atresia. [19][20][21] However, multiple anastomoses do lead to increased morbidity [2,22] and in addition, an inordinate increase in operating time is often not conducive to a favorable outcome in our institutional setup. Fortunately, multiple atresias are usually localized, [22] so that resection with a single anastomosis is very often an appropriate surgical option.…”

Section: Discussionmentioning

confidence: 99%

“…[20] However, preservation of as much bowel length as possible at the risk of creating a poorly functioning anastomosis, has little merit and can produce significant morbidity and mortality. [3,17] This is especially important if facilities for administration of TPN are lacking, as at our center.…”

Section: Discussionmentioning

confidence: 99%

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Treatment strategies in the management of jejunoileal and colonic atresia

Chadha

Sharma

Roychoudhury

et al. 2006

J Indian Assoc Pediatr Surg

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ABSTRACT ABSTRACT ABSTRACTBackground/Purpose: The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. Materials and Methods: There were 42 patients with jejunoileal atresia (JIA) and 4 with colonic atresia (CA). The 4 group types were: type I-membranous (n=20), type II-blind ends separated by a fibrous cord (n=6), type IIIa-blind ends with a V-shaped mesenteric defect (n=10), type IIIb-apple-peel atresia (n=4) and type IV-multiple atresias (n=6). Primary surgery for JIA consisted of resection with a single anastomosis (n=37), anastomosis after tapering jejunoplasty (n=3), multiple anastomosis (n=1) and a Bishop-Koop ileostomy (n=1). For CA, resection with primary anastomosis was performed. A single end-to-oblique anastomosis after adequate resection of dilated proximal bowel, was the preferred surgical procedure. In the absence of facilities for administering TPN, early oral/ nasogastric (NG) tube feeding was encouraged. In patients with anastomotic dysfunction, conservative treatment of the obstruction followed after its resolution by gradually increased NG feeds, was the preferred treatment protocol. Results: Late presentation or diagnosis with hypovolemia, electrolyte imbalance, unconjugated hyperbilirubinemia (n=25) and sepsis (n=6), were significant preoperative findings. After resection and anastomosis, significant shortening of bowel length was seen in 16 patients (34.7%). Postoperative complications included an anastomotic leak (n=3), a perforation proximal to the anastomosis in 1 and anastomotic dysfunction in 5 patients. Full oral or NG tube feeding was possible only by the 13th to 31st postoperative day (POD), after the primary surgery in patients with anastomotic dysfunction and those undergoing reoperation. Overall, 38 patients survived (82.6%). Mortality was highest in patients with type IIIb or type IV JIA. Conclusions: Despite lack of ideal facilities for neonatal intensive care and administration of TPN, good results were achieved in the management of JIA and CA by following these principles: (1) adequate preoperative resuscitation, (2) meticulous surgical technique and a standardized surgical protocol, (3) early recognition of postoperative complications and their management by a uniform protocol and (4) wherever possible, early institution of oral or NG feeds, preferably by breast milk.

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“…19, 21 . In the present study mortality rate was high as 3 of the neonates were lost to the complications of operation although one of them did well for at least 2 months postoperative and was lost to follow up.…”

Section: Discussionmentioning

confidence: 99%

Apple Peel Small Bowel, A Review of Four Cases: Surgical and Radiographic Aspects

Akinola

Osuoji

2011

J. Nepal Paedtr. Soc.

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Background: Although apple peel intestinal atresia is rare and is associated with a high mortality and morbidity, there is a dearth of its report in African literature. This study reviews four of the cases seen in a state teaching hospital in Lagos, considering the radiographic findings, surgical management and outcome. A brief review of literature is also undertaken. Aims and Objectives: To correle the plain radiographic findings with the surgical findings of neonates gathered over a six year period and to evaluate their surgical management, hoping to further help improve management of such neonates' in future in resource limited regions such as ours. Methodology: It was a retrospective case series of four neonates who were brought in over a period of six years and operated after an initial plain abdominal X-ray. They were done as emergency cases, consent was obtained from their parents and the study was approved by the research and ethics committee. Operative findings were subsequently correlated with their radiographic findings and the surgical outcomes and follow up were documented. Conclusion: This study revealed that "the triple bubble sign" is a common radiographic finding in Apple Peel deformities, as well as gangrene of the jejunum and ileum at surgery.

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Jejunoileal atresia: A 27-year experience

Cited by 35 publications

References 8 publications

Intestinal Atresia: Experience at a Busy Center of North-West India

Intestinal Atresia: Experience at a Busy Center of North-West India

Treatment strategies in the management of jejunoileal and colonic atresia

Apple Peel Small Bowel, A Review of Four Cases: Surgical and Radiographic Aspects

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