Comparative outcomes in intestinal atresia: a clinical outcome and pathophysiology analysis.

OBJECTIVE: To describe the outcomes of 130 intestinal atresias between 1982 and 2007. METHODS: Records were analyzed for location, demographics, prenatal diagnosis, birth weight, associated anomalies, surgery, establishment of oral intake, re-interventions and mortality. Statistical analyses were performed using Fisher test and ANOVA. RESULTS: There were 59 duodenal (30 male), 63 jejuno-ileal (34 male) and 8 colonic atresias (3 male). Prenatal diagnosis was established in 27 (46%) duodenal (DA), 26 (41%) jejuno-ileal (JIA) and 1 (12.5%) colonic atresias (CA). The mean birth weights, 2,380.5 g (SD 988) DA, 2,814 g (SD 755) JIA and 3,153 g (SD 527) CA were significantly different (p = 0.011). The mean gestational ages were 36, 37 and 37 weeks in DA, JIA and CA, respectively (p-NS). Associated congenital anomalies were seen in 41 (76%) DA, 32 (52%) JIA and 3 (38%) CA (p = 0.08, NS). The median time to full oral feeds after surgery was 18 days in DA, 20 days in JIA and 15.6 days in CA, respectively (p > 0.05). Eight patients with DA and nine patients with JIA underwent repeat surgery for adhesive obstruction. Adhesive bowel obstruction was most common in the first year after surgery in both groups (15/17). Gastroschisis was seen in six (10%) of JIA and three (35%) of CA. Two patients in the JIA group underwent bowel lengthening. Patients with gastroschisis and those with associated anomalies needed prolonged duration of TPN after JIA correction. There was no mortality in the duodenal atresia and colonic atresia groups. Six patients in the JIA group died, three of severe atresias coupled with multiple anomalies and three of cholestasis and sepsis. CONCLUSION: Distal atresias are difficult to diagnose antenatally. Proximal atresias have a significantly lower birth weight than distal atresias. Associated anomaly screening is important in all atresias.

Prognostic factors in jejuno-ileal atresia.

OBJECTIVE: Primarily to study morbidity and mortality in jejuno-ileal atresias (JIA) and prognostic factors for outcome. Secondarily to look at the incidence of reintervention. METHODS: Retrospective review of 63 patients diagnosed with JIA over a 30-year period (1975-2005). RESULTS: Sixty-three patients (34 male) of mean gestational age 36 weeks and mean birth weight 2,858 g with JIA were studied. There were 14 type I, 14 type II, 16 type IIIA, 9 type IIIB, and 10 type IV atresias. Thirty-three patients (52%) had associated anomalies. Fifty-one patients underwent resection and anastamosis, five patients Bishop-Koop procedure, five ileostomies, and one strictureplasty. Intestinal dilatation severe enough to warrant surgical intervention was seen in seven patients with the more severe variants of atresia. Five tapering procedures, one Bianchi operation and one STEP procedure were performed. Average hospital stay was 41 days (8-332 days). Fifty-six were alive at follow ups averaging 1.7 years (6 months to 11 years). Nine patients needed reoperations for adhesions before the first year of life. There were seven deaths. Most patients who died had associated anomalies (P = 0.017) or types IV/V atresias (P = 0.007). CONCLUSION: Mild atresias have an excellent prognosis and long-term survival. Severe atresias are associated with longer PN support and secondary procedures for intestinal failure. Associated anomalies adversely affect outcomes in JIA.