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At least 19 recordsLinked to original sources
PubMed1988

New observations on the pathogenesis of multiple intestinal atresias.

It has been suggested that multiple intestinal atresias result from multiple ischemic infarctions of the intestinal tract. We have studied surgical material from 59 neonates with intestinal atresias seen at our hospital between 1975 and 1986. Forty (68%) patients had single intestinal atresias and 19 (32%) had multiple atresias. There were seven cases of hereditary multiple atresias seen in three families and 12 cases of nonhereditary multiple atresias. All hereditary cases had numerous type I or type II gastrointestinal atresias but none had type IIIa atresia. Six of the seven hereditary cases had multiple atresias in the small as well as large bowel. The 12 patients with nonhereditary atresias had various types of atresias but mesenteric or intestinal interruption was observed in only two patients. All patients with hereditary multiple intestinal atresias showed identical microscopic appearances in the small and large intestine, consisting of sieve-like multiple lumina, each surrounded by its own mucosa and muscularis mucosae but sharing a common muscle coat. There was no evidence of lanugo, bile pigments, or squames within the lumen distal to atretic segments in any of these patients. Six nonhereditary cases who had multiple septal atresias affecting only the small bowel demonstrated essentially similar lesions on microscopic examination as seen in hereditary cases. There was no evidence of arterial occlusion in the mesentery and lanugo, bile pigments, and squames could not be found distally in the intestinal contents in any of these cases. These pathologic findings suggest that all cases of hereditary multiple intestinal atresias and some cases of nonhereditary multiple intestinal atresias are a consequence of a malformative process of the gastrointestinal tract rather than an ischemic process.

Abnormalities, Multiple↗
PubMed1977

Gastroschisis complicated by intestinal atresia.

Gastroschisis complicated by intestinal atresia is a complex problem. Six cases are presented. A review of the literature and of our own cases shows a high mortality rate. Success or failure is related more to the pathology present than to any specific method of operative management. Resection and primary anastomosis is the favored method of treatment, as the intestine heals well in spite of its appearance. Primary closure of the abdominal wall musculature and skin is done whenever possible. A gastrostomy is used uniformly. Intravenous hyperalimentation is critical to survival of these babies and should be used early. The use of this therapeutic modality allows for the onset of gastrointestinal function spontaneously (often over prolonged periods of time) without nutritional deprivation. Intestinal atresias almost always are easy to identify in babies with gastroschisis. Extensive dissection and mobilization of this friable intestine is contraindicated in those babies in whom an atresia is not obvious but only suspected. In such cases the gastroschisis defect should be managed by whatever method is deemed appropriate and the baby observed while receiving intravenous nutritional support. If an atresia is present, it can be managed later in the baby's course by resection and primary anastomosis.

Abdominal Muscles↗
PubMedDate not supplied

[Treatment of intestinal atresia].

Thirteen cases of intestinal atresia are described: 9 jejunal and 4 ileal. The duration of pregnancy was significantly shorter and the birthweight significantly lower in jejunal than in ileal atresia. The proximal intestine was strongly dilated in 8/9 cases with jejunal atresia. This group also contains several complex and extended varieties of atresia. The postoperative mortality was 8%. Gastrointestinal functional disturbances occurred only in the group treated for jejunal atresia. These disturbances were temporary and occurred postoperatively in 2 cases but reoperation was mandatory in another 2 cases, once without functional success. There were no problems in the other cases. Ileal atresia is easy to treat and the result is always good. In contrast, the situation is much more challenging in cases of jejunal atresia: prematurity, higher incidence of complex and extended gastrointestinal malformations, impossibility to resect the dilated proximal segment, presence of a long under-developed distal segment. No problems have been observed after construction of a double stoma and restoration of the intestinal continuity. However a proximal stoma leads to important fluid and electrolyte losses, necessitating total parenteral nutrition. Functional gastrointestinal disturbances are frequently observed after end-to-side anastomosis in Y with mucous fistula. An end-to-end anastomosis can be combined with enteroplasty of the proximal distended bowel segment, eventually including the duodenum. Although the enteroplasty technique is an important progress in the treatment of neonates with extended types of jejunal atresia, transit problems cannot always be prevented by this procedure.

Birth Weight↗
PubMed1987

Myoelectric activity differences in acute and chronic models of lamb intestinal atresia.

Clinical and experimental investigations of intestinal atresia have reduced mortality and clarified etiology. However, the morbidity of this lesion remains excessive and its pathophysiology uncertain. The purpose of this project was to produce the first long-term model of intestinal atresia and thereby to study the motility of the adapting bowel. Intestinal atresia was induced in nine fetal lambs at midgestation by mesenteric avulsion. At term, this experimental group and eight control lambs underwent resection with anastomosis, decompression gastrostomy, and implantation of electrodes proximal and distal to the anastomosis. Vigorous resuscitation and constant intensive care were critical for survival. Slow wave activity (SWA) and spike potential activity (SPA) were recorded in the first 24 hours and every 48 hours thereafter for a 6-hour interval. Three of nine lambs with atresia and five of the eight control animals survived over 48 hours (chronic). Analysis of 220 hours of recording showed, in the first 24 hours of life, a statistically significantly different SWA of 16.4 cycles/min (+/- 1.15 SD) in the chronic atretic survivors compared with 13.1 cycles/min (+/- 2.6 SD) in the acute (died less than 48 hours) atretic group (P less than .05). The SWA of the chronic atretic survivors was similar to the SWA of the chronic nonatretic control animals, 15.1 cycles/min (+/- 1.4 SD). SPA was present on the first day of life in the microintestine of the chronic atresia group in contrast to the acute animals of this study and of Doolin and Hill's previous study. Delayed function has been attributed to the absence of SPA in the microintestine of acute models.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1990

Congenital intestinal atresia.

Surgery for infants with intestinal atresia has evolved along with the development of specialized neonatal surgical units. This once fatal condition now carries a better than 85% chance of survival and an excellent long-term prognosis. Recent advances in bowel preservation techniques have reduced morbidity and improved gut function in both the long and the short term.

Anastomosis, Surgical↗
PubMed1975

The pathogenesis of intestinal atresia.

The records of 28 patients with duodenal and 31 with jejunoileal intestinal atresia or stenosis were studied. Vomiting and abdominal distention were the most prominent symptoms; an unusual colon may be present in jejunal as well as ileal obstruction and is not pathognomonic for ileal obstruction. Intestinal atresia is associated with a high incidence of preterm babies but with a low incidence of intrauterine growth retardation. Fifty-three infants were operated upon; the overall survival rate was 79 per cent. The high percentage of mortality in duodenal obstruction is due to associated malformations. Theories of the pathogenesis of intestinal atresia do not seem to fit current clinical and experimental evidence in all patients. Possibly, different factors play a role in separate situations.

Abnormalities, Multiple↗
PubMed1986

Intestinal atresia and stenosis: a review comparing its etiopathogenesis.

Two theories were proposed originally to describe the development of congenital intestinal atresia. The theory of imperfect recanalization, the theory of vascular insufficiency, and studies which have been performed to validate each of these theories were reviewed. Specific causes of the development of vascular insufficiencies in different species were reviewed if literature was available. In utero vascular accidents have been incriminated as the major cause of congenital intestinal atresia distal to the duodenum. There was relatively little evidence to show that intestinal atresia is inherited in any species. Duodenal atresia may be caused by either an embryologic defect for which there is some evidence of inheritance or by a vascular accident. The pathogenic mechanism for intestinal atresia may be similar in most species.

Animals↗
PubMed1991

Umbilical cord ulceration and intestinal atresia: a new association?

In three fetuses, congenital intestinal atresia was associated with linear ulcerations of the umbilical cord. In two cases, hemorrhage was seen from the cord ulcer. Both fetuses required emergency cesarean section for fetal distress and were born anemic. The third fetus was mildly hydropic, attributed to hemorrhage, and was stillborn. The mechanism of the association could not be determined. These cases suggest a risk of prenatal umbilical cord hemorrhage in infants with intestinal atresia.

Adult↗
PubMed1986

Surgical management of multiple intestinal atresias.

The unusual problem of multiple intestinal atresias associated with jejunal atresia has been reviewed and seven cases have been summarized. Maintaining maximal bowel length without jeopardizing the patient is of utmost importance. The shish kebob technique has been illustrated in a patient with 15 obstructions. The other cases include one patient with the apple peel deformity and two with atresias associated with gastroschisis. Although these children are small in general, they are bright and otherwise healthy. The 90 percent mortality reported previously has been reversed by a combination of techniques and lessons learned from the leaders in pediatric surgery.

Humans↗
PubMed1978

Intestinal atresia.

Forty-five patients with intestinal atresia, including 20 with duodenal, 21 with jejunoileal, and 3 with colonic obstruction, were encountered at the Yale-New Haven Hospital between 1970 and 1976. The overall survival rate in the 43 operated cases was 93 per cent. The major reasons for the excellent operative survival with this malformation include: (1) the care received in a regional neonatal center; (2) the early recognition and appropriate case selection, denying operation unless mandated in babies with duodenal atresia and trisomy 21; (3) primary repair using modern surgical techniques which minimize anastomotic complications and the "blind-loop" and "short gut syndrome"; and (4) the use of uncomplicated long-term total parenteral nutrition in approximately one-half of operated cases.

Abnormalities, Multiple↗
PubMed1985

[Has prenatal ultrasonic diagnosis modified the prognosis of intestinal atresia? Results of a multicenter study].

A multicentric investigation concerning intestinal atresia diagnosed in french university hospitals from 1979 to 1983, has been done. Out of 96 exploitable cases coming from 8 centers, 28 correspond to intestinal atresias which had subject to prenatal echographic diagnosis: that is 29%. 15 of the 96 atresias were affected with trisomy. 21 which had not been recognised in utero. Concerning the isolated duodenal atresia, not accompanied by any other malformation, the post surgical evolution has been appreciated during the 12 months following the surgical operation. There was no statistically significant difference, in favour of the group of children whose malformation has been recognised in utero, concerning the number of post surgical complications. This result, apparently deceitful, can be explained by the early management of these malformations in specialised centers which have participated in this study.

Down Syndrome↗
PubMed1979

Complicated intestinal atresias.

In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction.

Abnormalities, Multiple↗
PubMed1986

Histochemical changes in intestinal atresia and its implications on surgical management: a preliminary report.

Histochemical studies of the intestine were performed on five neonates, three with intestinal atresia and two as normal controls. In this preliminary report, changes secondary to ischemia and obstruction were defined. It was shown that the ischemic changes were limited in extent both proximally and distally, and the obstructive changes were reversible. A conservative approach to resection in the management of intestinal atresia is suggested. Limited resection of the dilated proximal bowel together with the use of total parenteral nutrition will allow for a safe waiting period for the pathological changes to reverse themselves and effective peristalsis to return.

Acetylcholinesterase↗
PubMed1991

Gastroschisis and intestinal atresia.

Controversy exists over the best method of treating gastroschisis with concomitant intestinal atresia because the mortality in such patients is still high. We present our experience of 74 neonates with gastroschisis seen over a 17-year period. Four patients (5.5%) had intestinal atresia; 1 had only one small bowel atresia, 2 had double areas of atresia (one in the mid small bowel and the other in the proximal colon), and the remaining 1 had multiple areas of atresia. Atresia with gastroschisis conventionally has been treated by either primary anastmosis or by exteriorization. Three of the patients were treated by replacing the atretic bowel into the abdomen initially and exploring later (1 to 3 weeks) when the bowel appeared much more healthy, making the anastomosis easier and more secure. One patient with extreme jejunal dilatation was treated by creation of a Mikulicz fistula. All 4 of the patients survived the newborn period, but one of them died at 1 year of age due to total parenteral nutrition-induced chronic liver failure. Our experience is presented to emphasize this uncommonly used approach to this complex problem because it seems to be associated with a lower morbidity and mortality than other conventional approaches.

Abdominal Muscles↗
PubMed1987

Multiple intestinal atresias in two brothers.

Two brothers with multiple intestinal atresias, from jejunum to rectum, are reported. This syndrome with multiple atresias in small and large bowel and intestinal calcification is an entity of probably autosomal recessive inheritance.

Colon↗
PubMed1979

[Prenatal diagnosis of an intestinal atresia by means of ultrasound - case report and discussion (author's transl)].

An intestinal atresia was diagnosed by means of ultrasonography and amniofetography in the 34. gestional week. The discussion agendas are, how far the given ultrasonogramms are typical for fetal intestinal atresia and how much part was played by sonography and amniofetography by the search of diagnosis; further, whether already antenatal diagnosed intestinal abnormality justifies a fetal indicated cesarean section, which could be important for timing of the surgical performance and for the betterment of the perinatal situation.

Adult↗
PubMed1986

Intestinal atresia and stenosis: a review comparing its morphology.

A review of the literature on intestinal atresia of domestic animal species and humans was done. The 5 types of intestinal occlusions described in human infants are atresia type 1, atresia type 2, atresia type 3, stenosis, and the "apple peel" or "Christmas tree" deformity. The intestinal defects described in domestic animal species such as the bovine, equine and porcine are similar to those of human infants. The "T-formation", an intestinal defect of the bovine resembling atresia type 3, and rectal stricture, an acquired intestinal defect of the porcine resembling stenosis, were described recently. Intestinal atresia is similar in several species and these similarities raise the questions as to whether the pathogenic mechanism and possibly etiologies of intestinal atresia are similar in these species.

Animals↗
PubMed1985

A 13q- syndrome with extensive intestinal atresia.

The first autopsy case of a 13q- syndrome with extensive intestinal atresia, viz., absence of almost the entire jejunum and ileum, is reported. The absence of the mesentery and the histological properties of the intraperitoneal string-structures composed of some muscle layers resembling the tunica muscularis of the alimentary tract suggest that one of the causative agents of the atresia may be abnormalities of mesenteric vessels.

Abnormalities, Multiple↗