A Clinical Analysis of the Intestinal Atresia

(1)

99

Vol. 10, No, 2, December 2004

A Clinical Analysis of the Intestinal Atresia

Jinyoung Park, M.D.

Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea

Intestinal atresia is a frequent cause of intestinal obstruction in the newborn.

We reviewed the clinical presentation, associated anomalies, types of atresias, operative managements, and early postoperative complications in 36 cases of intestinal atresia treated at the Department of Surgery, Kyungpook National University Hospital between January 1994 and February 2003. Location of the lesion was duodenum in 17 patients, jejunum in 11 patients and ileum in 8 patients. The male to female ratio was 1: 1.4 in duodenal atresia (DA), 2.7: 1 in jejunal atresia (JA) and 7: 1 in ileal atresia CIA). The most common type was type III (41.1

%)

in DA, and type I (52.6

%)

in JA and IA. The most common presenting symptoms was vomiting(88.2

%)

in DA, but in jejunoileal atresia, vomiting(89.4

%)

and abdominal distension(89.4

%)

were the most common sign and symptom. All cases of DA were diagnosed by plain abdominal radiography. There were 6 cases of DA with congenital heart disease, 3 cases of DA with Down syndrome and 3 cases of JA with meconium peritonitis. Segmental resection was performed in 13 cases, duodenoduodenostomy in 11 cases, membrane excision in 7 cases, jejunojejuno- stomy in 2 cases, gastroduodenostomy in 2 cases and ileocolic anastomosis in 1 case. There were 9 postoperative complications including 3 each of anastomotic leakage, wound infection, and intestinal obstruction 3 cases. The mortality rate for DA was 11.8 % (2/17). Both deaths in DA were attributed to congenital heart disease. The mortality rate for JA was 18 % (2/10. Both cases died with sepsis and short bowel syndrome. (] Kor Assoc Pediatr Surg

10(2):99-106), 2004.

Index Words: Atresia, intestine, Duodenum, Jejunum, Ileum

Correspondence: Jinyoung Park, MD., Department of Surgery, School of Medicine, Kyungpook National University. #52 Samduk-2-ga, Choong-gu,

Daegu,

700-721, Korea.

Tel: 053)420-5605,

Fax:

053)421-0510 E-mail: [email protected]

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Table 1. Incidence

Duodenum Jejunum Ileum Total (%)

Male 7 8 7 22 (61.1 %)

Female 10 3 14 (38.9 %)

Total 17 11 8 36 (100 %)

Table 2. Gestational Age

Duodenal Jejunal Ileal

Total (%) atresia atresia atresia

< 37 wks 2 6 0 8 (22.2 %)

37-42 wks 15 5 8 28 (77.8 %)

Total 17 11 8 36 (100 %)

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Table 3. Birth Weight

Duodenal Jejunal Ileal

Total (%) atresia atresia atresia

< 2.5 kg 5 5 11 (30.6 %)

2.6 - 4.5 kg 12 6 7 25 (69.4 %)

Total 17 11 8 36 (100 %)

Table 4. Place of Birth and Prenatal Diagnosis Prenatal Surgeon's Other

Total (%) diagnosis hospital hospital

(+) 7 6 13 (36.1 %)

(-) 8 15 23 (63.9 %)

Total 15 21 36 (100 %)

(3)

Table 5. Maternal Polyhydramnios Duodenal Jejunal Ileal

Total (%) atresia atresia atresia

Yes 10 6 0 16 (44.4 %)

No 7 5

8

20 (55.6 %)

Total 17 11

8

36 (100 %)

Table 6. Symptoms

Duodenal Jejunal Ileal

Total atresia atresia atresia

Vomiting 15 10 7 32

Abdominal

distention 4 9

8

21

Jaundice

8

2 3 13

Lethargy

6

2 4 12

Feeding

intolerance ₄ ₀ ₀ ₄

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Table 7. Diagnostic Work-up

Duodenal atresia

Simple x-ray only 17

Simple x-ray +barium enema 0

Total 17

Table 8. Associated Anomalies

Duodenal atresia Congenital heart disease 6

Trisomy 21

3

Meconium peritonitis 0

Annular pancreas 2

Malrotation 1

Midgut volvulus 0

Anterior portal vein Gastroschisis Situs inversus

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5 6 11 (30.6 %)

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Table 9. Types of Duodenal Atresia Types Atresia with gap between blind ends (Type III) Atresia with continuity of bowel wall (Type I) Atresia with fibrous cord (Type II)

Wind-sock anomaly Stenosis

Total

Table 10. Types of Jejunoileal Atresia Types Atresia with continuity of bowel wall (Type I) Atresia with gap between blind ends (Type Ilia) Atresia with fibrous cord (Type II)

Apple-peel deformity (Type IIlb) Multiple atresia (Type IV)

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3

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Intestinal obstruction

Total 17

Table 12. Postoperative Complications

Leakage 1

Intestinal obstruction Wound infection Sepsis

Renal failure 0

Short bowel syndrome 0

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