Treatment strategies in the management of jejunoileal and colonic atresia

Abstract

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.

Early oral feeding following intestinal anastomoses in children is safe

“…Full oral feeding was achieved by 7 th day post-operative in 95% of the children, which is comparable to previous studies, although in one report, [13] full oral intake was achieved as late as 16 th day post-operative. Previous studies have shown that blood loss during the surgery was the only factor contributing to failure of early post-operative oral feeding.…”

Different varieties of colonic atresia in a series of 13 patients

“…Two of them developed complications because of unrecognized distal hypoganglionosis. Chadha et al [18] mentioned that prognosis was good in three of the four patients surviving resection and primary anastomosis for right-sided colonic atresia. Two patients had postoperative complications: one had an anastomotic leak and one had a dysfunction, which were successfully treated by other operations.…”

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

“…This has been achieved because of refinements in neonatal intensive care, operative technique, use of total parenteral nutrition (TPN), antenatal diagnosis and neonatal anesthesia [5]. However, survival rates in developing countries are still lower (58.3-71.5%) [4][5][6][7][8]. In two reports from India, survival rate of 82% and 80% has been reported in series of 46 patients of jejuno-ileal atresia (JIA) and colonic atresia (CA), and 15 patients of duodenal atresia (DA), respectively [9,10].…”