The role of preserved bowel and mesentery fixation in apple-peel intestinal atresia

Abstract

Objective This study explored the feasibility of mesoplasty with end-to-side anastomosis in the treatment of different apple-peel mesenteric defects with high jejunal atresia. Methods A retrospective analysis was performed on 42 premature infants admitted to the hospital between 2014 and 2021. Prenatal ultrasound scans revealed bowel dilatation. The patients experienced vomiting after birth and produced white or no meconium. Plain radiography showed double or triple bubble signs and the patients underwent emergency laparotomy. High jejunal atresia with different apple-peel atresia appearance was discovered intraoperatively, involving mobilization of the ileocecal region. Patients received end-to-side anastomosis between the enlarged blind pouch and atretic bowel, as well as mesoplasty. A jejunal feeding tube was placed trans-nasally. Patients were discharged after achieving full enteral feeding. We also reviewed the literature on the subject. Results Three patients died and 39 survived. The discharged patients were followed up for 12 months, and none showed post-operative complications such as intestinal obstruction, malnutrition, or chronic diarrhea. All surviving patients reached the expected height and weight for children of the same age. Conclusion For cases of high jejunal atresia with apple-peel intestinal atresia, mesoplasty may be a good option to avoid postoperative volvulus.

T-tube enterostomy in the management of apple-peel atresia: A case series from a single center

“…Operative intervention for surgical repair of such complex anatomy entails resection and anastomosis with or without enteroplasty. Recently, Han et al ( 11 ) studied mesopexy after primary anastomosis by retrograde small bowel mesentery fixation starting from the ileocecal region and proceeding around the enlarged blind pouch and reported mortality of 3 cases only from 42 patients. The other option for apple-peel atresia treatment is performing temporary stoma, which is sometimes indicated in cases with questionable bowel viability, significant peritonitis, or caliber discrepancies between both ends.…”

The multivariate cox regression model for complete enteral nutrition after primary anastomosis in neonates with intestinal atresia

“…Furthermore, the interruption of intestinal continuity makes the distal intestinal tract smaller because of long-term disuse atrophy, while the proximal intestinal tract expands passively due to obstruction. The diameter ratio of proximal and distal intestinal tubes reflects the size of distal intestinal tubes, and the distance from the anastomotic site to the ileocecal region represents the length of the distal slender bowels, all of which impair the efficiency of excretion ( 13 , 14 ). Many studies have shown that early feeding is beneficial for the recovery of gastrointestinal function.…”