Intestinal Atresia and Stenosis
Intestinal atresia is a term used to describe a complete blockage or obstruction of any part of the intestine.
Stenosis refers to a partial obstruction that results in a narrowing of the opening (lumen) of the intestine.
It may involve any part of gastrointestinal tract, but broadly it involves- duodenum, jejunum and ileum. Most atresias occur in distal ileum (36%), 13% occurs in proximal ileum. 31% occur in proximal jejunum and 20% occur inthe distal jejunum.
Duodenal Stenosis and Atresia
Type-1-(92%) there is obstructing web formed from mucosa and submucosa. Outwardly there is no muscular and mesentry defect.
Type-2-(1%)Two blind ends of the duodenum are connected with small fibrous baqnd and there is no mesenteric defect
Type-3-(7%)there is no connection between two blind ends of the duodenum. V-shaped defect is present in the mesentry
Approximately 50% of patients with duodenal atresias have some form of anomaly (eg, cardiac, anorectal, or genitourinary), and as many as 40% have trisomy 21. Hence, all neonates with duodenal atresia should be assessed for concomitant malformations. Growth retardation and polyhydramnios are often present prenatally.
Ultrasonography may indicate a dilated stomach and proximal duodenum. Polyhydramnios is present as the fetus is unable to swallow the amniotic fluid.
Common associated anomalies and chromosomal defects may be assessed by screening maternal serum and amniotic fluid.
In the Newborn:
- Clear or bilious emesis is evident within hours of birth, with or without abdominal distention.
- An aspirate of more than 20 mL of gastric contents should raise the
- Dehydration or failure to thrive should raise suspicion of stenosis or partial obstruction.
- X Ray abdomen: reveal the classic double-bubble sign, representing air in the stomach and proximal duodenum, which is associated with complete or near-complete duodenal obstruction. Contrast radiography using air or contrast may confirm the diagnosis
Initial resuscitation in terms of gastric decompression, fluid resuscitation and thermoregulation should be done. Unless malrotation with volvulus remains a concern, preoperative assessment of other associated anomalies should be performed. The definative tratment is surgery:
- Duodenotomy with excision of the web