Total intestinal atresia: Revisiting the pathogenesis of congenital atresias

Abstract

Despite various theories to explain the pathogenesis of atresias, the exact mechanism is still controversial. Currently, atresias are believed to result from vascular accidents and less likely due to the failure of recanalization. We report a case which challenges this belief. A 1-day-old neonate was explored for suspected jejunal atresia. Apart from Type III jejunal atresia, 15 cm from DJ junction, there was surprisingly no distal lumen in the intestine from jejunum till rectum. Multiple enterotomies revealed the whole of the remaining jejunum, ileum, and large colon to be a solid cord-like structure. No distal luminal contents or histopathological evidence of ischemic damage was seen, thus suggesting the probable etiology to be a failure of recanalization of the gut cord rather than a late vascular accident. Such rare cases provide insights into possible embryogenetic mechanisms which can then aid in formulating preventive measures.

Kaposiform hemangioma of jejunum in a newborn: A case report and review of literature

“…Classically, newborns with bilious vomiting are considered to be potentially surgical and require higher attention. Also, they cannot be discharged until thorough evaluation [ 1 ]. Intestinal atresias are mostly suspected in the prenatal period through ultrasound with polyhydramnios due to the non-swallowing of the swallowed amniotic fluid.…”

“…The presence of bilious vomiting in the newborn is associated with surgical pathologies, most commonly with intestinal atresia [ 1 ]. However, some rare differential diagnoses must be remembered [ 2 ].…”

Water in the Belly- a Review of Current Knowledge About Ascites in Children

“…Bowel obstruction is the most common cause of isolated fetal ascites which in itself is a rare finding [39]. Intestinal atresia is one of the most prevalent reasons for bowel obstruction in neonates with small bowel obstruction accounting for majority of cases, whereas colonic atresia is quite rare [40]. Increased pressure in the obstructed bowel may lead to perforation and ascites in the mechanism of meconium peritonitis.…”

“…Atresia without perforation may also lead to ascites in transducative mechanism [1]. Treatment of unperforated intestinal atresia is surgical removal of the obstruction [40]. Later management is dependent on the outcome of the surgery and might involve nutritional treatment and further surgical or medical interventions [41].…”