Jejuno-Ileal atresia

Abstract

Jejunoileal atresia is a frequent cause of intestinal obstruction in the newborn, with a prevalence of 0.7-0.8 per 10,000 live births with a trend towards increased prevalence amongst Black infants at 1.4 per 10,000 live births. There is a low incidence of chromosomal anomalies compared to duodenal atresia. Antenatal diagnosis is easier to identify in the more proximal atresias. Newborn infants present with symptoms and signs of intestinal obstruction, confirmed on abdominal radiogram. The classification is now well defined into stenosis and types I to IV, with types III and IV being associated with reduced viable bowel length. The treatment of choice is resection of the bulbous blind proximal bowel back to a more equal calibre and primary end to end anastomosis. Multiple anastomoses may be required in type IV atresia. Other techniques, using various types of stomas initially, have been used, but there should be the realization that grossly dilated bowel does not return to normal calibre. If the remaining bowel length is short, various techniques have been used to preserve bowel length and reduce proximal bowel lumen diameter to preserve maximal absorptive mucosal surface area and prograde peristalsis. The long-term outcome is good for the majority of children, the end result being influenced by the residual bowel length and its absorptive and peristaltic function, morbidity of any associated anomalies and the successful management of the short bowel syndrome.