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Ileal atresia.

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Humans↗

Tissue levels of bilirubin and biliverdin in the sea lamprey, Petromyzon marinus L., before and after biliary atresia.

1. Liver, intestine, kidney, muscle and epidermis from larvae, juvenile adults and upstream migrants of the sea lamprey, Petromyzon marinus L., were assayed for the presence of biliverdin and bilirubin. Urine was also examined for these bile pigments in juveniles and upstream migrants. 2. Bilirubin concentration increased dramatically in the liver and caudal intestine following loss of larval bile ducts while biliverdin levels were highest in the liver of upstream migrants and rose sharply in the caudal intestine immediately following the atresia. 3. Small amounts of bile pigment were present in larval kidneys but high concentrations were found in this organ in upstream migrants. The urine of the latter possessed biliverdin. 4. Mucus of the epidermis may be a vehicle for transport and release of bilirubin in upstream migrants. 5. These data indicate that lampreys utilize different avenues for bile pigment storage and elimination over the course of their life cycle.

Animals↗

Gastroschisis: what part can the obstetrician play?

In order to assess the contribution of antenatal diagnosis to the management of gastroschisis, the antenatal and postnatal data from 24 cases of gastroschisis observed between 1974 and 1990 were re-examined. The frequency of antenatal diagnosis (29%), polyhydramnios (21%), atresia of the small intestine (29%), length of pregnancy (36.6 +/- 2 weeks of amenorrhea), proportion of cesarean sections (21%), birth weight (2230 +/- 430 g) and the Apgar score after 5 min (9.0 +/- 1.5) were comparable to findings reported elsewhere. The overall mortality rate for the period studied was high (41%), and was not influenced by any antenatal parameter or by the mode of delivery; its recent fall (P = 0.01) is explained by the development of therapeutic methods. These results are consistent with other recent studies and suggest that antenatal diagnosis does not enable an accurate assessment of the prognosis to be made and has no major influence on the mortality rate in gastroschisis.

Abdominal Muscles↗

Familial jejunal atresia with 'apple-peel' variant.

We report two siblings who had jejunal atresia which we believe to be familial. The parents of these siblings were first cousins. The first child had jejunal atresia with mesenteric agenesis and 'apple-peel' configuration; the second child had jejunal atresia with a V-shaped mesenteric defect. Other reported cases of familial atresia of the small intestine are reviewed.

Humans↗

Ileal atresia with segmental defect of intestinal musculature.

An unusual case of segmental defect of ileal musculature with terminal ileal atresia and ventricular septal defect is reported. Clinically the patient was diagnosed as ileal atresia. On exploration, there was type I atresia at ileocaecal junction with attendant ileal dilatation and an adjoining 5 cm x 4 cm segment resembling segmental dilatation of ileum, about 15 cm proximal to ileocaecal junction. Pathological examination of segmentally dilated ileum revealed focal absence of circular and longitudinal muscle coat without any evidence of necrosis or inflammation. The possible etiology and its relationship with congenital segmental dilatation of intestine is discussed.

Female↗

Biliary atresia associated with meconium peritonitis caused by perforation of small bowel atresia.

BACKGROUND/PURPOSE: This report describes our experiences with 5 cases of biliary atresia associated with meconium peritonitis caused by perforation of small bowel atresia. METHODS: A review of medical records was undertaken in an effort to recognize cases of biliary atresia associated with meconium peritonitis. RESULTS: Five patients of 171 with biliary atresia (2.9%) were detected to have meconium peritonitis caused by perforation of small bowel atresia. The biliary atresia was not suspected during the initial operation for meconium peritonitis. Total parenteral nutrition (TPN) made it difficult to make an early differential diagnosis of biliary atresia because of the presence of TPN-associated cholestatic jaundice, and the Roux-en-Y limb used for hepatic portoenterostomy could not be made long enough to prevent cholangitis caused by preexisting short bowel. The main complications were severe, intractable cholangitis, short bowel syndrome with malnutrition; TPN-associated liver injury; and wound problems. Two patients died of ascending cholangitis, 1 patient of liver failure that was exacerbated by TPN-associated liver injury, and 1 patient is awaiting a liver transplant. Only 1 patient is in good health, being anicteric and showing normal growth and development. CONCLUSIONS: Biliary atresia is evidently closely associated with meconium peritonitis caused by perforation of small bowel atresia. The management of these patients is more difficult than that of patients with the usual form of biliary atresia, because of the necessity for a long period of TPN and the combined short bowel syndrome. The ideal management of these conditions has yet to be determined.

Biliary Atresia↗