Colo-recto-anal atresia with congenital patent ceco-vesical fistula: a case report.
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This paper describes an unusual case of ileal atresia associated with an omphalomesenteric duct (OMD) remnant. A 1-day-old male developed bilious vomiting and abdominal distension. At laparotomy, the distal portion of the ileum was connected to the umbilicus with a fibrous band. Around this omphalomesenteric band, the ileum was strangulated and necrotic; the end of the ileum was atretic. Apart from these structures, the cecum terminated without mesentery. This experience shows evidence of an OMD remnant as a possible cause of jejunoileal atresia.
An evaluation of patients with meconium peritonitis shows that, apart from the fibro-adhesive type, the (Pseudo) cystic and the generalized type, a fourth type can be distinguished. In a case of this fourth type, the "microscopic" type of meconium peritonitis, no signs of a peritonitis are found on macroscopic examination of the abdominal cavity. Conversely, microscopic examination will reveal meconium components focally outside the bowel. The clinical and histological data of 14 patients are discussed. It is pointed out that a significantly large number of patients with meconium peritonitis also have atresia of the small bowel. Based on the patient evaluation, a hypothesis is brought forward concerning the pathogenesis of these atresias.
A newborn girl developed a distension of the abdomen within a few hours after birth. A plain abdominal film showed multiple dilated bowel loops, with the widest in the right lower abdomen. At surgery atresia of the ascending colon was found.
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Hyperplasia is the main change occurring in intestinal smooth muscle above a chronic obstruction and explains the functional obstruction seen in the proximal bowel of a jejunoileal atresia. With an experimental model in dogs, this hyperplasia has been shown to be reversible. However, changes are extreme in atresia, and experiments in animals with induced atresia will best evaluate various kinds of treatment.
Since 1976, the authors have used T-tube drainage for the treatment of diaphragmatic type, high jejunal atresia. Twelve cases were operated on. All cases survived the operation. On the fourteenth to thirtieth postoperative day, T-tubes were removed when the dilated proximal intestine returned to normal size.
Pyloric atresia and epidermolysis bullosa are both rare anomalies, and the coincidental occurrence of both is highly unlikely. The postmortem findings of 2 unrelated cases is presented, with special reference to the pathology and pathogenesis of pyloric atresia.