Intestinal Atresia and Stenosis

Intestinal atresia is a broad term used to describe a complete blockage or obstruction anywhere in
the intestine.
Stenosis refers to a partial obstruction that results in a narrowing of the opening (lumen) of the
intestine.
Though these conditions may involve any portion of the gastrointestinal tract, the small bowel is
the most commonly affected portion.
The frequencies, symptoms and methods of diagnosis differ depending on the site of intestinal
involvement. evertheless, children with all forms of intestinal atresia require surgical treatment.
Show !ll
Types of Intestinal Atresia
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Pyloric Atresia
#yloric atresia involves an obstruction at the pylorus, which is the passage linking the stomach
and the first portion of the small intestine (duodenum).
This is quite rare, and tends to run in families. $hildren vomit stomach contents, and due to the
accumulation of intestinal contents and gas, develop a swollen (distended) upper abdomen.
!bdominal %&rays reveal an air&filled stomach but no air in the remaining intestinal tract.
Pyloric Atresia
Duodenal Atresia
The duodenum is the first portion of the small intestine that receives contents emptied from the
stomach.
'uodenal atresia occurs in one out of every (,)** live births. "alf of the infants with this
condition are born prematurely and appro+imately two&thirds have associated abnormalities of
the heart, genitourinary or intestinal tract. early ,* percent have 'own syndrome. Infants with
duodenal atresia usually vomit within hours after birth, and may develop a distended abdomen.
!bdominal %&rays show a large dilated stomach and duodenum without gas in the remaining
intestinal tract.
Duodenal Atresia - Example 1 Duodenal Atresia - Example 2
Jejunoileal Atresia
-e.unoileal atresia involves an obstruction of the middle region (.e.unum) or lower region (ileum)
of the small intestine.
The segment of intestine .ust before the obstruction becomes massively enlarged (dilated), thus
hindering its ability to absorb nutrients and propel its contents through the digestive tract. In /*
percent to /) percent of infants with .e.unoileal atresia, part of the intestine dies during fetal
development. ! significant percentage of infants with this condition also has abnormalities of
intestinal rotation and fi+ation.
$ystic fibrosis is also an associated disorder and may seriously complicate the management of
.e.unoileal atresia. Infants with .e.unoileal atresia should be screened for cystic fibrosis.
Four sutypes of jejunoileal atresia
Types of Jejunoileal Atresia
Atresia type I! The blockage is created by a membrane (web) present on the inner aspect
of the intestine. The intestine usually develops to a normal length.
Atresia type II! The dilated intestine terminates as a blind end. It is connected to a
smaller caliber segment of the intestine by a fibrous scar. The intestine develops to a
normal length.
Atresia types IIIa and III! The blind ends of intestine are separated by a defect in the
intestinal blood supply. This often leads to a significantly shortened intestinal length that
may result in long&term nutritional deficiencies or the short gut syndrome.
Atresia type I"! 0ultiple regions of obstruction e+ist. This may result in a very short
length of useful intestine.
Infants with .e.unoileal atresia, regardless of the subtype, usually vomit green bile within the first
(, hours of life. "owever, those with obstructions farther down in the intestine may not vomit
until two to three days later. Infants often develop a swollen (distended) abdomen and may not
have a bowel movement (as is normally e+pected) during the first day of life. 1iven the age of
the patient and the symptoms, an abdominal %&ray is usually sufficient to establish a diagnosis.
#olonic Atresia
This rare form of intestinal atresia accounts for less than /)2 of all intestinal atresias. The bowel
becomes massively enlarged (dilated), and patients develop signs and symptoms similar to those
associated with .e.unoileal atresia. $olonic atresia may occur in con.unction with small bowel
atresia, "irschsprung3s disease or gastroschisis. The diagnosis is confirmed by an abdominal %&
ray along with an %&ray contrast enema
Dia$nosis of Atresia and Stenosis
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Intestinal obstructions are increasingly being identified through prenatal ultrasounds. This
imaging technique may indicate e+cess amniotic fluid (polyhydramnios), which is caused by the
failure of the intestine to properly absorb amniotic fluid.
If your physician suspects intestinal atresia or stenosis, your infant will undergo the following
diagnostic procedures after being stabili4ed5
Adominal %-ray! In most cases, this can establish a diagnosis.
&o'er $astrointestinal ()I* series! This is a procedure that e+amines the rectum, large
intestine and lower part of the small intestine. !n %&ray contrast agent is given into the
rectum as an enema6 this coats the inside of the intestines, allowing them to be seen on an
%&ray. !n abdominal %&ray may show narrowed areas (strictures), obstructions, the width
(caliber) of the bowel and other problems.
+pper )I series! This procedure e+amines the organs of the upper part of the digestive
system. It is particularly useful in cases where there is an upper intestinal obstruction
(pyloric or duodenal atresia). ! liquid called barium, which shows up well on %&rays, is
given orally or administered through a small tube placed through the mouth or nose into
the stomach. %&rays are then taken to evaluate the digestive organs.
Adominal ultrasound! 7ltrasonography is an imaging technique used to view internal
organs as they function, and to assess blood flow through various vessels. 1el is applied
to the abdomen and a special 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. ! picture or videotape of the
test is also made so it can be reviewed later.
'ue to the high percentage of infants born with intestinal atresia who also have associated, life&
threatening abnormalities, echocardiography and other imaging studies of the cardiac and renal
regions may also be performed after the infant is stabili4ed.
Find Anot,er #ondition or Treatment

Intestinal Atresia and Stenosis
Intestinal atresia is a broad term used to describe a complete blockage or obstruction anywhere in
the intestine.
Stenosis refers to a partial obstruction that results in a narrowing of the opening (lumen) of the
intestine.
Though these conditions may involve any portion of the gastrointestinal tract, the small bowel is
the most commonly affected portion.
The frequencies, symptoms and methods of diagnosis differ depending on the site of intestinal
involvement. evertheless, children with all forms of intestinal atresia require surgical treatment.
Show !ll
Types of Intestinal Atresia
Show
Dia$nosis of Atresia and Stenosis
Show
Treatment of Intestinal Atresia and Stenosis
"ide
$hildren with intestinal atresia and stenosis require an operation, and the e+act type of operation
differs depending on the location of the obstruction.
#rior to the operation, all babies must be stabili4ed. The e+cess intestinal contents and gas that
contribute to abdominal swelling (distention) is removed through a tube that is placed into the
stomach through the mouth or nose.
8emoving air and fluid from the intestinal tract can prevent vomiting and aspiration, and reduce
the risk of bowel perforation. It also provides babies with some comfort as abdominal swelling is
relieved. Intravenous fluids are given to replace vital electrolytes (minerals and salts in the
bloodstream and body) and fluid that have been lost through vomiting. 9nce the baby is
stabili4ed, surgery is performed to repair the obstruction.
Pyloric Atresia
The pyloric obstruction is opened and the stomach passageway is repaired. The success of this
operation is e+cellent. :ength of hospital stay is generally one to three weeks. "owever, as in all
types of intestinal atresia, the hospital stay is substantially longer for premature infants.
Duodenal Atresia and Stenosis
'uodenal atresia and stenosis are managed by connecting the blocked segment of duodenum to
the portion of duodenum .ust beyond the obstruction. !dditionally, a tube may be temporarily
placed through a surgical opening in the abdominal wall (gastrostomy) to drain the stomach and
protect the airway. This tube can also be used for feeding if needed.
#arents can e+pect their child to remain in the hospital from one to several weeks, until the
child3s diet is sufficient to permit adequate nutrition.
Jejunoileal Atresia and Stenosis
;ith .e.unoileal atresia, the type of surgery depends on the type of atresia, the amount of
intestine present and the degree of intestinal dilation.
The most common operation involves removal of the blind intestinal segments, and the
remaining ends are closed with sutures. Similarly, a narrowed (stenosed) segment of the intestine
can be removed and the bowel sutured together, thus establishing intestinal continuity.
#olonic Atresia
<abies with colonic atresia may undergo removal of the enlarged (dilated) colon in addition to a
temporary colostomy. :ess frequently, the ends of colon are sutured together.
Infants -it, Intestinal Atresia and Stenosis
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<abies with atresia are managed with a nasogastric tube that is left in place until their bowel
function returns. This may vary from a few days to several weeks.
'uring the period of bowel inactivity, nutrition is provided intravenously. 9nce the intestinal
function is normali4ed, nutrition is provided orally or through a feeding tube.
&on$-Term .utloo/
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$hildren who undergo surgery for intestinal atresia require regular follow&up to ensure adequate
growth and development, and to avoid nutritional deficiencies that may occur as a result of the
loss of intestine.
"ow babies progress depends to a large e+tent on whether there is an associated abnormality and
whether the baby is left with an adequate length of intestine.
In general, however, most babies do well. $omplications after surgery are rare, but may occur. In
the immediate to early postoperative period, intestinal contents may leak at the suture line where
the ends of the bowel were sewn together. This may cause an infection within the abdominal
cavity and require additional surgery.
$omplications that may later occur include malabsorption syndromes, functional obstruction due
to an enlarged and paraly4ed segment of intestine, or short gut syndrome.