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Intestinal atresia is a congenital (present at birth) malformation that involves the complete absence or closure of a part of the intestine. Intestinal stenosis is a narrowing of the intestine that causes partial blockage. Intestinal atresia is common in the duodenum, jejunum and ileum, which make up the small intestine and is rare in the colon. Intestinal atresia accounts for 33 percent of all cases of intestinal obstruction at birth.
If not treated promptly, intestinal atresia and stenosis can lead to damage of the intestines.
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Intestinal obstruction occurs in approximately 1 out of every 1500 live births.
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The cause of most types of intestinal atresia is secondary to an in utero vacular accident. Obstruction of the jejunum may occur in response to another congenital anomaly, such as volvulus (a twisting of the intestine), malrotation of the intestine, hernia, intussusception, or abdominal wall defects such as gastroschisis or omphalocele, that can involve strangulation of the small intestine, which interrupts its blood supply.
About half of infants born with duodenal obstruction are premature, more than 30 percent have Down's syndrome and 50 to 75 percent have associated anomalies including cardiac, renal, and other gastrointestinal defects.
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The symptoms of intestinal atresia and stenosis depend on the cause, where in the intestine the obstruction is and how long the condition is left untreated. The classic symptoms include:
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- Failure to tolerate feedings
- Nausea and Vomiting
- Bilious vomiting
- Intermittent, abdominal pain
- Abdominal distention (sometimes)
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Symptoms of intestinal atresia and stenosis may resemble other conditions or medical problems. Please consult your child's physician for a diagnosis.
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With increasing frequency, these kinds of obstructions are identified on prenatal ultrasound after the finding of polyhydramnios (excess amniotic fluid), which is caused by the intestine's failure to properly absorb amniotic fluid. If your doctor suspects intestinal atresia or stenosis, your newborn will undergo the following diagnostic procedures after he/she is stabilized:
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- Abdominal X-ray:
- lower GI (gastrointestinal) series (also called barium enema) A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
- Abdominal ultrasound - A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or video tape of the test is also made so it can be reviewed in the future.
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Other imaging studies of the cardiac and renal regions may also performed after the baby is stabilized to check for anomalies associated with intestinal atresia. Approximately one-third of the infants with intestinal atresia will have an associated life-threatening anomaly.
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Specific treatment for intestinal atresia will be determined by your child's physician based on the following:
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- the extent of the problem
- location of the obstruction
- your child's age, overall health, and medical history
- the opinion of the physicians involved in the child's care
- your opinion or preference
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The initial treatment for duodenal atresia or stenosis involves stabilizing the baby. This process involves the decompression of excess gas. A baby with this condition has a distended and gas-filled stomach. The gas is decompressed through a tube that is placed into the stomach through the nose or mouth. Intravenous fluid replacement is also administered to replace vital electrolytes that a baby with this condition typically loses due to vomiting. Once the baby is stabilized, surgery is performed to fix the obstruction. Surgery involves excision of the obstructed part of the duodenum, followed by rejoining or reconnection of the healthy parts of the duodenum. In addition, a tube may be temporarily implanted through a surgical opening in the abdominal wall (gastrostomy), to drain the stomach and protect the airway. Nutrition will be administered intravenously until the infant is able to feed orally.
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Babies with this kind of obstruction must also be initially stabilized before the problem is corrected. This usually involves intravenous fluid replacement to maintain adequate fluid and electrolyte balance. Antibiotics will also be administered to treat any infections that result from this condition. Surgical correction involves the resection of the dilated proximal portion of the bowel followed by rejoining of the two ends of the bowel.
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In children who have had an intestinal atresia or stenosis surgically corrected, feedings are started when a bowel movement is observed and gastric drainage and volume are minimal. Your baby's doctor will start your baby on a special formula that can be easily digested. When increases are tolerated, the density and volume can be increased to full strength.
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How these babies fare heavily depends on whether there is an associated anomaly and whether or not the baby is left with an adequate length of intestine. Most babies do well, but some complications can occur such as gastroesophageal reflux. Your child's doctor will want to monitor your baby regularly after surgery.
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Intestinal Atresia and Stenosis
