Jejunoileal Atresia & Stenosis

Question 1

Etiology

Answer 1

The most favored theory is the localized intrauterine vascular accident with ischemic necrosis of the sterile bowel

Question 2

Type 1

Answer 2

The obstruction is caused by membrance or web formed by mucosa & submucosa. The dilated proximal & distal collapsed bowels are in continuity without mesenteric defect.

Question 3

Type2

Answer 3

The proximal bowel connects to the collapsed distal bowel by short fibrous cord, the mesentry is intact in both type I & II & the total length of small bowel is normal

Question 4

Type 3a

Answer 4

Proximal & distal bowels are disconnected ( the fibrous band is absent ) & V – shaped mesenteric defect of varying size is present. The total length of bowel is subnormal.

Question 5

Type 3b

Answer 5

Apple – peel or Christmas tree) consist of proximal jejunal atresia near the ligament of Tretiz , absence of SMA* beyond the origin of celiac branch . Large mesenteric defect with significant loss in intestinal length is present

Question 6

Type 4

Answer 6

There`s multiple segment atresia combination of types I,II & III. Grossly shortened bowel length & high mortality.

Question 7

Clinical Manifestations:

Answer 7

[1]Polyhydramnios during pregnancy.

[2] Bilious vomiting on the 1 st day of life.

[3] Dehydration.

[4] Fever.

[5] Unconjugated hyperbilirubinemia.

[6] Abdominal distension.

[7] 60-70% of these neonates fail to pass meconium on the 1 st day of life .

[8] Although meconium may appear normal it is more common to find: Grey Plugs of mucus passed via the rectum.

[9] Signs of ischemia & peritonitis (tenderness, rigidity, edema and erythema of abdominsal wall)

Question 8

, Diagnosis

Answer 8

[1] Clinical findings.

[2] Plain X – ray of abdomen that shows few gases – filled & fluid - filled loops of small bowel, but the remainder of the abdomen is gasless. Air – fluid level may be scanty & may become evident only after decompression via NG tube.

Question 9

Management

Answer 9

1) Resuscitation (I.V. fluids, NG tube, ABS).
2) Surgery depends on pathological findings.

Resection of proximal dilated or hypertrophied bowel with primary end – to end anastomosis with or without tapering of the proximal bowel is the most common surgery
_type 4
<3 Cm → resection
>3CM→local resection & anastamosis