Intestinal atresia and stenosis

Abstract

Congenital atresia and stenosis of the small intestine are classified into the four groups. Type I: The obstruction is caused by a membrane or web. Type II: Blind-ending proximal loop connected by a fibrous cord. Type III(a): The atresia ends blindly with no fibrous connecting with a mesenteric defect. Type III(b): "Apple peel-type" atresia consists of a proximal jejunal atresia and the absence of the superior mesenteric artery. Type IV: Multiple-segment atresia. Access to the entire intestine is necessary to evaluate the type and location of the intestinal atresia. The first step is to determine the continuity of the distal segment by injection of sterile saline into the distal bowel lumen. The bulbous hypertrophied proximal end should be resected. If there is not enough length, plication of this portion may be effective in improving peristalsis. End-to-end and end-to-back anastomosis is preferred between bowel ends of different size. A one-layer interrupted inverted technique using fine monofilament absorbable sutures is the most preferred technique to adjust the diameter difference. When a primary anastomosis is contraindicated in cases of severe discrepancy of the diameter or unstable patient's condition, a staged operation is considered as a safer strategy.