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388 Intestinal Atresia and Stenosis
Prevention Table 63.1: Evidence-based research.
Unfortunately, there are no options at present for prevention because Title Jejuno-ileal atresia and stenosis
these anomalies are usually not recognized prior to birth.
Authors Rode H, Millar AJW
Ethical Issues Institution Red Cross Children’s Hospital, Cape Town, South Africa
In resource-poor regions without recourse to intensive care and par- Reference In: Prem Puri, ed. Newborn Surgery, 2nd ed. Arnold, 2003,
enteral nutrition, infants with ultra-short bowel resulting from con- Pp 445–456
genital atresia may have to be managed conservatively. Discussion Problem Late presentation of jejunoileal atresia and stenosis in Africa.
around parental expectations and centre outcomes should be part of Intervention Surgery is curative if presentation is early enough.
the informed consent. Nursing staff and other caregivers should also Comparison/ Before 1952, the mortality for jejunoileal atresia alone was
be party to the decision-making process. Withdrawal of treatment that control 90%. Between 1952 and 1955, the mortality was 80%
is thought to be futile is often difficult to institute. If there are choices (quality of when primary anastamosis was performed without bowel
to be made based on allocation of limited resources, then infants with evidence) resection. Between 1955 and 1958, the mortality decreased
to 22% due to liberal resection of the dilated loop and
the potential for good outcomes may be given preference for meagre primary anastomosis. From 1959 to 2000, the mortality has
resources. However, it is only the infrequent case of intestinal atresia decreased to 10%. Factors contributing to mortality were type
that develops intestinal failure, and with prompt operation and preser- III atresia, proximal bowel infarction, peritonitis, anastomotic
vation of as much functioning bowel as possible, prognosis should be leaks, missed distal atresias, short bowel syndrome, sepsis,
and human immunodeficiency virus (HIV) infection.
excellent.
Outcome/ The survival rate is more than 90% in well-resourced
Evidence-Based Research effect countries, but 40–50% in Africa, where no nutritional support
Table 63.1 presents a study of the change in mortality rates from jeju- is available and presentation is late.
noileal atresia and stenosis over a nearly 50-year period. Historical No advancement on vascular theory for aetiology. A variant of
significance/ multiple intestinal atresias may have a familial/genetic cause.
comments

Key Summary Points
1. Intestinal atresia may occur at any level of the gastrointestinal 5. The primary surgery for intestinal atresia consists of a
tract. generous back resection of the bulbous blind end and an end-
2. Small bowel atresia in most cases is due to an antenatal to-end anastomosis.
ischaemic insult to a segment of intestine. Resorption of the 6. Outcomes are generally good if sufficient bowel length
infarcted segment leads to occlusion of the lumen, with a remains.
varying degree of dilatation of the proximal blind end.
7. Stomas should be avoided.
3. One-third of infants with intestinal atresia are born prematurely. 8. The mortality rate depends on birth weight, residual bowel
4. Differential diagnoses include midgut volvulus, meconium ileus, length, the degree of dysmotility, associated anomalies, and
extensive aganglionosis, and intussusception. septic complications.

References

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70:558–564. Ashcraft KW, Holder TM, eds. Pediatric Surgery, Saunders, 2000,
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