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.2016 Oct 10;5(4):51.
doi: 10.21699/jns.v5i4.405. eCollection 2016 Oct-Dec.

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

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

Shilpi Gupta et al. J Neonatal Surg..

Abstract

Objective: To evaluate the presentation, management, complications and outcome of intestinal atresia (IA) managed at our center over a period of 1 year.Materials and methods: Records of patients of IA admitted in our center from January 2015 to December 2015 were retrospectively analyzed. Demographic data, antenatal history, presenting complaints, location (duodenal, jejunoileal, colonic) of atresia, surgery performed and peri-operative complications were noted.Results: Total 78 cases of IA were included in the analyses. Mean age and weight at the time of presentation was 5.8 days (range 0-50), and 1.9 kg (range 1.1-3.2), respectively. IA included duodenal atresia [DA (32)], jejuno-ileal atresia [JIA (40)], colonic atresia [CA (3)] and atresia at multiple-location (sites) in 3 cases. Ninety percent of patients underwent surgery within 5 to 20 hours of admission. All cases of DA except one underwent Kimura's diamond shaped duodeno-duodenostomy. One case with perforated duodenal web underwent duodenotomy with excision of web. Seven patients with JIA and CA required primary stoma, while rest were managed by excision of dilated proximal segment and primary anastomosis. Complications included anastomotic leak in 5, proximal perforation in 2, functional obstruction in 7, aspiration pneumonitis in 3, and wound infection in 6 patients. Mean hospital stay for survivors was 11 days. Overall survival was 63%.Conclusion: Late presentation, overcrowding in intensive care unit, septicemia, functional obstruction and anastomotic leak are the causes of poor outcome in our series. Early diagnosis, some modification in surgical technique, use of total parenteral nutrition and adequate investigations for other congenital anomalies may improve the outcome.

Keywords: Intestinal atresia; Intestinal obstruction; Neonatal.

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Figures

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Figure1: Double-bubble appearance with distal gas in a case of perforated duodenal web (A); double-bubble sign with red rubber catheter in upper esophageal pouch in a case of triple atresia (B); Double-bubble sign with pneumoperitoneum in a case of duodenal atresia with gastric perforation (C).
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Figure 2: Triple-bubble sign (A) in a case of jejunal atresia; dilated bowel loops with a few air-fluid levels in a case of jejunal atresia (B); dilated bowel loops with multiple air-fluid levels a case of ileal atresia (C); gastrografin enema showing unused colon in a case of ileal atresia (D,E).
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Figure 3: Intra-operative images showing dilated stomach and proximal duodenum (A), with perforated duodenal web (B); ileal web (C); jejunal atresia type II (D), jejuno-ileal atresia type IIIb (E); type IV jejuno-ileal atresia (F).
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Table 1: Type of atresia, management and survival (%) in current study
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Table 2: Management and outcome of complications in current study
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