This membrane generally blocks the intestine, but the intestine itself gets its normal length. Familial type 1 jejunal atresias and renal dysplasia. Jejunal and ileal atresia andobstruction jejunoileal atresia have been attributed tointrauterine vascular accidents leading to ischemicnecrosis of the sterile bowel and resorption of theaffected segments. The small intestine is the tubeshaped organ between the stomach and large intestine, which includes the duodenum, jejunum, and ileum, where most food digestion and nutrient absorption take place. The fact that there was some meconium passed, and there are some filling defects in the colon suggest that the atresia has been the result of a relatively late ischemic cause. Type iiib most commonly shows familial occurrence, although familial cases of types i, ii, and iv have also been observed.
Intestine atresia an overview sciencedirect topics. The surgeons aim is to preserve as much bowel length as possible, to avoid. Atresias of the jejunum and ileum are common causes of bowel obstruction in. Intestinal atresia and stenosis treatment, diagnosis, and. The babys intestine usually grows to normal length.
In type iiia, 2 blind ends terminate with a vshaped mesenteric defect. Longterm complications of congenital esophageal atresia andor. We studied them in detail with respect to their antenatal diagnosis, clinical features, associated anomalies, operative procedures performed, complications and outcome. Predictive factors for postoperative outcome in children. There are different types of intestinal atresia, depending on where the closure occurs. Associated type iiib and type iv multiple intestinal atresia. Oct 26, 2016 jejunal atresia is a birth defect in a newborn characterized by partial or complete absence of the membrane connecting the small intestines to the abdominal wall the mesentery. Type i is characterized by a thin diaphragm that occludes the lumen. Jejunal atresia is a birth defect in a newborn characterized by partial or complete absence of the membrane connecting the small intestines to the abdominal wall the mesentery. It causes the esophagus to end in a blindended pouch rather than connecting normally to the stomach. Polyhydramnios occurs in 25% of affected patients monozygotic twins are at higher risk premature birth occurs in 30% of infants. Described for the first time in 1683 1 jejunoileal atresia is among the most. The intestinal villi play a major role in nutritional absorption, but type 3 intestinal atresia results in nutritional deficiency and gut syndrome.
It comprises a variety of congenital anatomic defects that are caused by an abnormal embryological development of the esophagus. Currently, there are no guidelines or methods available for the prevention of jejunal atresia. Stenosis refers to a partial obstruction that results in a narrowing of the opening lumen of the intestine. Type iiia atresia 15% is similar to type ii, but there is a mesenteric defect and the bowel length may be foreshortened. There are 4 main types of ileal atresia with subtypes. Type iv jejunal atresia with an unusual variation of. Intestinal obstruction in neonatalpediatric surgery. Jejunal atresia nord national organization for rare disorders.
Pyloric atresia the obstruction is at the pylorus, which is the passage linking the stomach and the first portion of the small intestine duodenum. This segment of bowel was the cystic structure detected prenatally and preoperatively on exam. Pediatric laparoscopic surgery duodenal atresia duodenaljejunal anastomosis duration. In this case two blind ends of the intestine are separated which reduces the length of the intestine.
Jejunal atresia, atresia jejuni definition of jejunal. Type iiib atresia 19% apple peel or christmas tree deformity consists of a proximal jejunal atresia, often with malrotation with absence of most of the mesentery and a varying length of ileum. To our knowledge, this association has never been reported before. The blockage is created by a membrane web present on the inner aspect of the intestine. Chapter 39 laparoscopic treatment of duodenal and jejunal.
Longterm complications of congenital esophageal atresia. Apr 16, 2019 compared with patients with ileal atresia, patients with high jejunal atresia had a higher rate of associated congenital malformations 42% vs 2%, a higher rate of multiple or applepeel type iiib atresias 53% vs 9%, and a higher mortality. Presentation of intrauterine diagnosis and clinical course of fetal jejunal atresia. Type iv atresia is a multiple atresia of types i, ii, and iii, like a string of sausages. The characteristics of jejunal and ileal atresias in this study were also different in many aspects table 3. Intestinal atresia is classified according to the cause of the blockage figure 2. Jejunal atresias have a strong familial tendency, especially the apple peel type. Esophageal atresia is a congenital medical condition birth defect that affects the alimentary tract. A two ends of atresia separated by v shaped mesenteric defect b christmas tree deformity bowel distal to the atresia receives its blood supply in a retrograde fashion from ileocolic or right colic artery type 4 mutliple atresias string of sausage or string of beads. In type ii, 2 blind ends are connected with a fibrous cord of atretic bowel.
The dilated and obstructed proximal small bowel along with microcolon confirms the diagnosis of jejunal atresia. A collection of disease information resources and questions answered by our genetic and rare diseases information specialists for jejunal atresia. Jejunoileal atresia merck manuals professional edition. In type iiib, also known as the apple peel or christmas tree deformity, the atresia affects the jejunum, and the intestine is often malrotated with most of the mesenteric arteries absent. Type iv jejunal atresia with an unusual variation of enteric. The patient was born with type lllb jejunal atresia, complicated by volvulus of the terminal ileum. Three members of a family in two generations with proximal jejunal atresia and renal dysplasia are described. Intestinal atresia type i posted on march 9, 2012 by admin it is a variety of intestinal obstruction in newborns called intestinal atresia type i which means that there is an external continuity but a membrane with a central hole in between which allows some air to pass but there is bilious vomiting. It is connected to a smaller caliber segment of the intestine by a fibrous scar. These procedures are associated with a higher prevalence of longterm respiratory and esophageal complications. Intestinal atresia is one of the most frequent causes of bowel obstruction in the newborn and can occur at any point in the gastrointestinal tract. The type 1 jejunal atresia is not a true atresia as it consists of a web with complete or incomplete obstruction 1, 2.
Abdominal radiograph demonstrating the characteristic doublebubble sign associated with duodenal atresia. Intestinal atresia is a broad term used to describe a complete blockage or obstruction anywhere in the intestine. Intestinal atresia and stenosis treatment, diagnosis. Type iiib bowel is foreshortened and variably cannulized with absent mesentery and small or absent superior mesenteric artery. Pyloric atresia is rare, and tends to run in families.
Type iiib is jejunal atresia with absence of the distal superior mesenteric artery. Type iiib atresia 19% apple peel consists of a proximal jejunal atresia, often with malrotation with absence of most of the mesentery and a varying length of ileum surviving on perfusion from retrograde flow along a single artery of supply. Type 3 duodenal atresia dilated short segment of bowel distal duodenumproximal jejunum between a proximal type 3 duodenal atresia and a distal type 3b jejunal atresia apple peel configuration, forming an enteric cystic structure about 8 cm in diameter containing dark green bile bile duct cbd opened into this enteric cystic structure. Multiple intestinal atresia mia is a complex congenital defect which represents a challenge for the pediatric. An atresia is a congenital defect of a hollow viscus that results in complete obstruction of the lumen.
Martin and zerella 1976 proposed a classification of jejunal atresia into 5 types according to anatomic appearance. While applepeel intestinal atresia is usually reported. A primary anastomosis was performed in 33 70% of the patients, while 19 40% patients received a primary stoma. The blockage, which can be partial or complete, is caused by a weblike membrane that forms inside the intestine while the baby is developing in the womb. Jejunal atresia nord national organization for rare. It causes a portion of the small intestines the jejunum to twist around an artery that supplies blood to the colon the marginal artery. Intestinal atresia is a congenital complete obstruction of the bowel lumen. The type and location of the atresia were equally distributed among type i to iv and jejunumileum, respectively. Pathological types of duodenal atresia and stenosis noted in the current series. Predictive factors for postoperative outcome in children with.
The remaining ileum, which is of varying length, survives on a single mesenteric artery, which it is twisted around in a spiral form. Most newborns with intestinal obstruction present with abdominal distention and bilious emesis in the first 2 days of life, though the presentation can be delayed for weeks in infants with stenosis. Though these conditions may involve any portion of the gastrointestinal tract, the small bowel is the most commonly. Intestinal obstruction in neonatalpediatric surgery by c. Jejunal atresia is a birth defect in which the fold of the stomach membrane needed to connect the small intestine to the back wall of the abdomen is, in part, absent. Jejunal atresia genetic and rare diseases information center. Dec 30, 2010 we report a rare case of type iv jejunal atresia with enteric duplication and multiple diverticuli, found in a 3dayold baby girl. The incomplete obstruction as seen in this case has a webmembrane. Intestinal atresia is a congenital obstruction of the intestine, sometimes associated with a loss of tissue, resulting in a disruption of intestinal continuity. In this case, a membrane gradually forms inside of the intestine when the baby is in its mothers womb. Jejunal atresia genetic and rare diseases information. Hajivassiliou glasgow, scotland, uk intestinal obstruction in the newborn infant and older child may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal. Type iv consists of multiple atretic segments resembling a string of sausages.
Short bowel syndrome genetic and rare diseases information. He was left with 40 cm of small bowel and his ileocecal valve. Jan 17, 2019 type iiib, applepeel or christmastree atresia, involves a large, vshaped mesenteric defect in which the blindended bowel distal to the atresia is wrapped around its blood supply. The intestine develops and gets its length, but there is an involvement of scar tissue. Intestinal atresia or stenosis can occur anywhere along the gastrointestinal gi tract, and the anatomic location of the obstruction determines the clinical presentation. Jun 18, 20 jejunal and ileal atresia andobstruction jejunoileal atresia have been attributed tointrauterine vascular accidents leading to ischemicnecrosis of the sterile bowel and resorption of theaffected segments. Exploration revealed a type 3 duodenal atresia followed by a type 3b proximal jejunal atresia apple peel configuration, with a dilated short segment of bowel between the two. Pdf intestinal atresias are a common cause of bowel obstruction in. However, the incidence of jejunal atresia at birth in the. Applepeel intestinal atresia, also known as type iiib or christmas tree intestinal atresia, is a rare form of small bowel atresia in which the duodenum or proximal jejunum ends in a blind pouch and the distal small bowel wraps around its vascular supply in a spiral resembling an apple peel. Associated type iiib and type iv multiple intestinal. Applepeel intestinal atresia radiology reference article. A blind end formation occurs in the intestine, and. Combined duodenal and jejunal atresia forming a bile filled.
A very rare case of intestinal atresia, the apple peel syndrome. Infants often develop a swollen distended abdomen and may not have a bowel movement jejunoilal is normally expected. That is, the proximal superior mesenteric artery is occluded, and the distal small intestine spirals around its vascular supply of collaterals from the ileocolic. A majority of the patients had the bulbous end of the intestine resected, 39 83%. Combined duodenal and jejunal atresia forming a bile. This page was last edited on 17 aprilat surgery is performed in most of the cases of jejunoileal atresia, but it depends upon the types of the intestinal atresia. Results fetal small bowel atresias are relatively frequent malformations with the incidence of 12500 to 5000 live births. Apr 14, 2014 type iiib atresia 19% apple peel consists of a proximal jejunal atresia, often with malrotation with absence of most of the mesentery and a varying length of ileum surviving on perfusion from retrograde flow along a single artery of supply. Stenosis 33% type ii atresia 12% type i atresia 43% type iii atresia 12% figure 2.
The significant differences between jejunal and ileal atresia were the increased duration between presentation and surgery pvalue 0. Associated type iiib and type iv multiple intestinal atresia in a pediatric patient. Treatment strategies in the management of jejunoileal and. Multiple intestinal atresia mia is a complex congenital defect which represents a challenge for the pediatric surgeon, especially in the rare event of encountering type iiib or apple peel atresia, which has a high mortality rate. Type iv atresia is a multiple atresia of types i, ii, and iii, like a string of. The causes of short bowel syndrome in adults include. As a result, a portion of the small intestine the jejunal twists about one of the arteries to the colon. This association is presumably an autosomal dominant condition. We report a rare case of type iv jejunal atresia with enteric duplication and multiple diverticuli, found in a 3dayold baby girl. Short bowel syndrome is a disorder characterized by malabsorption of nutrients due to problems involving the small intestine.
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