Intestinal atresia

aesculapian condition
Intestinal atresia is any congenital malformation of the structure of the intestine that causes bowel obstruction. The malformation can be a narrowing ( stenosis ), absence or malrotation of a part of the intestine. These defects can either occur in the small or bombastic intestine .

Symptoms and signs [edit ]

The most outstanding symptom of intestinal atresia is atrabilious vomiting soon after parturition. [ 1 ] This is most common in jejunal atresia. [ 2 ] other features include abdominal dilatation and bankruptcy to pass meconium. The distention is more popularize the far down the intestine the atresia is located and is thus most big with ileal atresia. [ 1 ] [ 2 ] Inability to pass stool is most common with duodenal or jejunal atresia ; [ 2 ] if fecal matter is passed, it may be small, mucus-like and grey. [ 1 ] occasionally, there may be jaundice, which is most park in jejunal atresia. [ 2 ] Abdominal tenderness or an abdominal multitude are not by and large seen as symptoms of intestinal atresia. Rather, abdominal affection is a symptom of the deep complication meconium peritonitis. [ 1 ] Before birth, overindulgence amniotic fluid ( polyhydramnios ) is a possible symptom. This is more common in duodenal and oesophageal atresia. [ 1 ]

induce [edit ]

The most common cause of non-duodenal intestinal atresia is a vascular accident in utero that leads to decrease intestinal perfusion and ischemia of the respective segment of intestine. [ 3 ] This leads to narrowing, or in the most severe cases, accomplished eradication of the intestinal lumen. [ citation needed ] In the case that the lake superior mesenteric artery, or another major intestinal artery, is occluded, bombastic segments of intestine can be entirely developing ( Type III ). Classically, the involve area of intestine assumes a spiral shape and is described to have an “ apple undress ” like appearance ; this is accompanied by lack of a dorsal mesentery ( Type IIIb ). [ citation needed ] An inherit class – familial multiple intestinal atresia – has besides been described. This disorderliness was beginning reported in 1971. [ 4 ] It is due to a mutant in the gene TTC7A on short arm of chromosome 2 ( 2p16 ). It is inherited as an autosomal recessive allele gene and is normally fatal in infancy. Ileal atresia can besides result as a complication of meconium intestinal obstruction. [ citation needed ] A third base of infants with intestinal atresia are born prematurely [ 1 ] or with abject give birth weight. [ 2 ]

diagnosis [edit ]

intestinal atresias are much discovered before birth ; either during a act sonogram which shows a elaborate intestinal segment ascribable to the blockage, or by the growth of polyhydramnios ( the buildup of besides a lot amniotic fluid in the uterus ). These abnormalities are indications that the fetus may have a intestine obstruction which a more detail sonography cogitation can confirm. [ 5 ] Infants with stenosis rather of atresia are much not discovered until respective days after birth. [ 1 ] Some fetuses with intestine obstacle have abnormal chromosomes. An amniocentesis is recommended because it can determine not only the sexual activity of the pamper, but whether or not there is a trouble with the chromosomes. [ citation needed ] If not diagnosed in utero, infants with intestinal atresia are typically diagnosed at day 1 or day 2 after presenting with eating problems, vomiting, and/or failure to have a intestine motion. [ 3 ] diagnosis can be confirmed with an roentgenogram, and typically followed with an amphetamine gastrointestinal serial, lower gastrointestinal series, and ultrasound. [ 5 ] [ 3 ]

categorization [edit ]

By location [edit ]

intestinal atresia may be classified by its location. Patients may have intestinal atresia in multiple locations. [ 6 ]

  • Duodenal atresia – malformation of the duodenum, part of the intestine that empties from the stomach, and first section of the small intestine
  • Jejunal atresia – malformation of the jejunum, the second part of the small intestine extending from the duodenum to the ileum, that causes the jejunum to block blood flow to the colon [7]
  • Ileal atresia – malformation of the ileum, the lower part of the small intestine
  • Colon atresia – malformation of the colon

Malformations may besides occur along multiple portions of the intestinal tract ; for exemplify a deformity that occurs along or spans the duration of the jejunum and the ileum is termed jejunoileal atresia. [ 5 ] [ 3 ]

By deformity [edit ]

intestinal atresia can besides by classified by the type of malformation. [ 8 ] The classification system by Bland-Sutton and Louw and Barnard ( 1955 ) [ 9 ] initially divided them into three types. [ 8 ] [ 5 ] This was late expanded to five by Zerella and Grosfeld et aluminum. [ 2 ]

type I [edit ]

In type I, there is a wall ( septum ) or membrane at some point in the intestine, leading to dilation of the intestine on the approximate side and a collapse of the intestine on the latter side. Bowel duration is not normally affected in this type. [ 1 ]

Type II [edit ]

In type II, there is a gap in the intestine, and either end of the remaining intestine is closed off and connected to the other by a fibrous cord that runs along the edge of the mesentery. The mesentery remains integral. [ 1 ]

character IIIa [edit ]

Type IIIa is similar to type II, but the mesentery is bad ( there is a v-shaped opening ), [ 10 ] and the intestine duration may be shortened. [ 1 ]

type IIIb [edit ]

In type IIIb, besides known as the “ apple undress ” or “ Christmas tree ” disfigurement, the atresia affects the jejunum, and the intestine is frequently malrotated with most of the mesenteric arteries absent. The remaining ileum, which is of varying length, survives on a single mesenteric artery, which it is twisted around in a spiral kind. [ 1 ] The term apple-peel intestinal atresia is broadly reserved for when it affects the jejunum, [ 11 ] [ 12 ] while Christmas tree intestinal atresia is used if it affects the duodenum. It may affect both, however. [ 6 ]

type intravenous feeding [edit ]

Type IV involves a combination of all the early types and takes the appearance of a string of sausages. The distance of the intestine is always shortened, but the final share of the ileum is normally not affected, as in type III. [ 1 ] This type normally affects the nearest end of the jejunum, but the far end of the ileum may rather be affected. [ 13 ]

treatment [edit ]

Fetal and neonatal intestinal atresia are treated using laparotomy after birth. If the area affected is small, the surgeon may be able to remove the damaged helping and join the intestine back together. In instances where the narrowing is longer, or the area is damaged and can not be used for menstruation of time, a irregular stoma may be placed. [ citation needed ] The baby is normally given intravenous fluid hydration, and a nasogastric or orogastric tube may be used to aspirate the contents of the stomach. The nutritional administration is maintained after operating room until the intestine can resume normal officiate. [ 1 ]

prognosis [edit ]

complication of ileal atresia, meconium peritonitis, in which the intestine perforated before parentage. x ray shows meconium pseudocyst. prognosis is normally good if treated with surgery in infancy. The main factor in deathrate is the handiness of care and appropriate parenteral nutrition after surgery until the intestine can resume normal affair. [ 1 ] The most coarse complication is pseudo-obstruction at the site of operating room due to preexistent intestinal dysmotility. This can normally alone be treated by non-surgical methods. [ 1 ] If the atresia is not treated, the intestine may become pierced or ischemic. This can lead to abdominal affection and meconium peritonitis, which can be fatal. [ 1 ]

epidemiology [edit ]

Intestinal atresia occurs in around 1 in 3,000 births in the United States. [ 1 ] The most common form of intestinal atresia is duodenal atresia. It has a hard affiliation with Down syndrome. [ 14 ] The second-most common character is ileal atresia. 95 % of congenital jejunoileal obstructions are atresia ; entirely 5 % are stenoses. [ 2 ] prevalence of jejunoileal atresia is 1 to 3 in 10,000 populate births. It is weakly associated with cystic fibrosis, intestinal malrotation, and gastroschisis. [ 3 ] The frequencies of each type from Louw and Barnard ‘s classification are as follows : [ 1 ] [ 15 ] [ 2 ]

  • Type I: 19–23% of cases (mean: 20.6%)
  • Type II:10–35% of cases (mean: 25.3%)
  • Type IIIa: 15%–46% of cases (mean: 30%)
  • Type IIIb (“apple-peel” type): 4–19% of cases (mean: 8.8%)
  • Type IV: 6–32% of cases (mean: 15.9%). (Note: the mean percentages total higher than 100% due to rounding.)

history [edit ]

Ileal atresia was first described in 1684 by Goeller. In 1812, Johann Friedrich Meckel reviewed the subject and speculated on an explanation. In 1889, English surgeon John Bland-Sutton proposed a categorization system for intestinal atresia and suggested that it occurs at areas that are obliterated as separate of normal growth. In 1900, austrian doctor Julius Tandler first put forward the theory that it may be caused by lack of recanalisation during development. [ 2 ]

The vascular ischemic campaign of non-duodenal atresia was confirmed by Louw and Barnard in 1955 and was repeated in former studies. It had first been proposed by N. I. Spriggs in 1912. [ 2 ]

See besides [edit ]

References [edit ]

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