Intestinal atresia and stenosis: A 25-year experience with 277 cases

Laura K. Dalla Vecchia, Jay L. Grosfeld, Karen W. West, Frederick Rescorla, L. R. Scherer, Scott A. Engum

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the causes, clinical presentation, diagnosis, operative management, postoperative care, and outcome in infants with intestinal atresia. Design: Retrospective case series. Setting: Pediatric tertiary care teaching hospital. Patients: A population-based sample of 277 neonates with intestinal atresia and stenosis treated from July 1, 1972, through April 30, 1997. The level of obstruction was duodenal in 138 infants, jejunoileal in 128, and colonic in 21. Of the 277 neonates, 10 had obstruction in more than 1 site. Duodenal atresia was associated with prematurity (46%), maternal polyhydramnios (33%), Down syndrome (24%), annular pancreas (33%), and malrotation (28%). Jejunoileal atresia was associated with intrauterine volvulus, (27%), gastroschisis (16%), and meconium ileus (11.7%). Interventions: Patients with duodenal obstruction were treated by duodenoduodenostomy in 119 (86%), of 138 patients duodenotomy with web excision in 9 (7%), and duodenojejunostomy in 7 (5%) A duodenostomy tube was placed in 3 critically ill neonates. Patients with jejunoileal atresia were treated with resection in 97 (76%) of 128 patients (anastomosis, 45 [46%]; tapering enteroplasty, 23 [24%]; or temporary ostomy, 29 [30%]), ostomy alone in 25 (20%), web excision in 5 (4%), and the Bianchi procedure in 1(0.8%). Patients with colon atresia were managed with initial ostomy and delayed anastomosis in 18 (86%) of 21 patients and resection with primary anastomosis in 3 (14%). Short-bowel syndrome was noted in 32 neonates. Main Outcome Measures: Morbidity and early and late mortality. Results: Operative mortality for neonates with duodenal atresia was 4%, with jejunoileal atresia, 0.8% and with colonic atresia, 0%. The long-term survival rate for children with duodenal atresia was 86%; with jejunoileal atresia, 84%; and with colon atresia, 100%. The Bianchi procedure (1 patient, 0.8%) and growth hormone, glutamine, and modified diet (4 patients, 1%) reduced total parenteral nutrition dependence. Conclusions: Cardiac anomalies (with duodenal atresia) and ultrashort-bowel syndrome (<40 cm) requiring long-term total parenteral nutrition, which can be complicated by liver disease (with jejunoileal atresia), are the major causes of morbidity and mortality in these patients. Use of growth factors to enhance adaptation and advances in small bowel transplantation may improve long-term outcomes.

Original languageEnglish
Pages (from-to)490-497
Number of pages8
JournalArchives of Surgery
Volume133
Issue number5
DOIs
StatePublished - May 1998

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Intestinal Atresia
Pathologic Constriction
Ostomy
Newborn Infant
Duodenal Obstruction
Total Parenteral Nutrition
Mortality
Duodenostomy
Colon
Gastroschisis
Short Bowel Syndrome
Morbidity
Polyhydramnios
Intestinal Volvulus
Meconium
Ileus
Postoperative Care
Tertiary Healthcare
Down Syndrome
Glutamine

ASJC Scopus subject areas

  • Surgery

Cite this

Dalla Vecchia, L. K., Grosfeld, J. L., West, K. W., Rescorla, F., Scherer, L. R., & Engum, S. A. (1998). Intestinal atresia and stenosis: A 25-year experience with 277 cases. Archives of Surgery, 133(5), 490-497. https://doi.org/10.1001/archsurg.133.5.490

Intestinal atresia and stenosis : A 25-year experience with 277 cases. / Dalla Vecchia, Laura K.; Grosfeld, Jay L.; West, Karen W.; Rescorla, Frederick; Scherer, L. R.; Engum, Scott A.

In: Archives of Surgery, Vol. 133, No. 5, 05.1998, p. 490-497.

Research output: Contribution to journalArticle

Dalla Vecchia, LK, Grosfeld, JL, West, KW, Rescorla, F, Scherer, LR & Engum, SA 1998, 'Intestinal atresia and stenosis: A 25-year experience with 277 cases', Archives of Surgery, vol. 133, no. 5, pp. 490-497. https://doi.org/10.1001/archsurg.133.5.490
Dalla Vecchia, Laura K. ; Grosfeld, Jay L. ; West, Karen W. ; Rescorla, Frederick ; Scherer, L. R. ; Engum, Scott A. / Intestinal atresia and stenosis : A 25-year experience with 277 cases. In: Archives of Surgery. 1998 ; Vol. 133, No. 5. pp. 490-497.
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abstract = "Objective: To evaluate the causes, clinical presentation, diagnosis, operative management, postoperative care, and outcome in infants with intestinal atresia. Design: Retrospective case series. Setting: Pediatric tertiary care teaching hospital. Patients: A population-based sample of 277 neonates with intestinal atresia and stenosis treated from July 1, 1972, through April 30, 1997. The level of obstruction was duodenal in 138 infants, jejunoileal in 128, and colonic in 21. Of the 277 neonates, 10 had obstruction in more than 1 site. Duodenal atresia was associated with prematurity (46{\%}), maternal polyhydramnios (33{\%}), Down syndrome (24{\%}), annular pancreas (33{\%}), and malrotation (28{\%}). Jejunoileal atresia was associated with intrauterine volvulus, (27{\%}), gastroschisis (16{\%}), and meconium ileus (11.7{\%}). Interventions: Patients with duodenal obstruction were treated by duodenoduodenostomy in 119 (86{\%}), of 138 patients duodenotomy with web excision in 9 (7{\%}), and duodenojejunostomy in 7 (5{\%}) A duodenostomy tube was placed in 3 critically ill neonates. Patients with jejunoileal atresia were treated with resection in 97 (76{\%}) of 128 patients (anastomosis, 45 [46{\%}]; tapering enteroplasty, 23 [24{\%}]; or temporary ostomy, 29 [30{\%}]), ostomy alone in 25 (20{\%}), web excision in 5 (4{\%}), and the Bianchi procedure in 1(0.8{\%}). Patients with colon atresia were managed with initial ostomy and delayed anastomosis in 18 (86{\%}) of 21 patients and resection with primary anastomosis in 3 (14{\%}). Short-bowel syndrome was noted in 32 neonates. Main Outcome Measures: Morbidity and early and late mortality. Results: Operative mortality for neonates with duodenal atresia was 4{\%}, with jejunoileal atresia, 0.8{\%} and with colonic atresia, 0{\%}. The long-term survival rate for children with duodenal atresia was 86{\%}; with jejunoileal atresia, 84{\%}; and with colon atresia, 100{\%}. The Bianchi procedure (1 patient, 0.8{\%}) and growth hormone, glutamine, and modified diet (4 patients, 1{\%}) reduced total parenteral nutrition dependence. Conclusions: Cardiac anomalies (with duodenal atresia) and ultrashort-bowel syndrome (<40 cm) requiring long-term total parenteral nutrition, which can be complicated by liver disease (with jejunoileal atresia), are the major causes of morbidity and mortality in these patients. Use of growth factors to enhance adaptation and advances in small bowel transplantation may improve long-term outcomes.",
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N2 - Objective: To evaluate the causes, clinical presentation, diagnosis, operative management, postoperative care, and outcome in infants with intestinal atresia. Design: Retrospective case series. Setting: Pediatric tertiary care teaching hospital. Patients: A population-based sample of 277 neonates with intestinal atresia and stenosis treated from July 1, 1972, through April 30, 1997. The level of obstruction was duodenal in 138 infants, jejunoileal in 128, and colonic in 21. Of the 277 neonates, 10 had obstruction in more than 1 site. Duodenal atresia was associated with prematurity (46%), maternal polyhydramnios (33%), Down syndrome (24%), annular pancreas (33%), and malrotation (28%). Jejunoileal atresia was associated with intrauterine volvulus, (27%), gastroschisis (16%), and meconium ileus (11.7%). Interventions: Patients with duodenal obstruction were treated by duodenoduodenostomy in 119 (86%), of 138 patients duodenotomy with web excision in 9 (7%), and duodenojejunostomy in 7 (5%) A duodenostomy tube was placed in 3 critically ill neonates. Patients with jejunoileal atresia were treated with resection in 97 (76%) of 128 patients (anastomosis, 45 [46%]; tapering enteroplasty, 23 [24%]; or temporary ostomy, 29 [30%]), ostomy alone in 25 (20%), web excision in 5 (4%), and the Bianchi procedure in 1(0.8%). Patients with colon atresia were managed with initial ostomy and delayed anastomosis in 18 (86%) of 21 patients and resection with primary anastomosis in 3 (14%). Short-bowel syndrome was noted in 32 neonates. Main Outcome Measures: Morbidity and early and late mortality. Results: Operative mortality for neonates with duodenal atresia was 4%, with jejunoileal atresia, 0.8% and with colonic atresia, 0%. The long-term survival rate for children with duodenal atresia was 86%; with jejunoileal atresia, 84%; and with colon atresia, 100%. The Bianchi procedure (1 patient, 0.8%) and growth hormone, glutamine, and modified diet (4 patients, 1%) reduced total parenteral nutrition dependence. Conclusions: Cardiac anomalies (with duodenal atresia) and ultrashort-bowel syndrome (<40 cm) requiring long-term total parenteral nutrition, which can be complicated by liver disease (with jejunoileal atresia), are the major causes of morbidity and mortality in these patients. Use of growth factors to enhance adaptation and advances in small bowel transplantation may improve long-term outcomes.

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