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     LETTER TO THE EDITOR

CONCOMITANT JEJUNOILEAL AND COLONIC ATRESIAS


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Authors:  Muhammad Riazulhaq*, Elbaqir Elhassan, Diaa Eldin Mahdi, Adel Mutawalli

Institute: Department of Pediatric Surgery, King Faisal Hospital Taif, Saudi Arabia

Address for Correspondence: Dr. Muhammad Riazulhaq, FCPS,FEBPS Children Surgeon, King Faisal Hospital, Taif- Saudi Arabia P.O Box 7390.

*Email: riaz_rao@hotmail.com

* Corresponding Author

 


ISSN:2226-0439

Journal of Neonatal Surgery

Volume 1(2), Apr-Jun 2012


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Submitted On: 20-12-2011

Accepted On: 06-01-2012

 Published on: 01-04-2012

Local ID: jns-1-24

J Neonat Surg 2012; 1(2): 33

© Riazulhaq et al, 2012

Conflict of Interest: None declared

Source of Support: Nil

 


How to cite:

Riazulhaq M, Elhassan E, Mahdi DE, Mutawalli A. Concomitant jejunoileal and colonic atresias. J Neonat Surg 2012; 1: 33.

 


 

DEAR SIR

Intestinal atresia is fourth common cause of neonatal intestinal obstruction [1]. Colonic atresia is relatively rare with an incidence of 1:40,000 to 1:60,000 live births. Coexisting jejunoileal and colonic atresias are scarcely described in literature [2,4,5]. 

A full term male baby, weighing 2.9 kg, presented to us with neonatal intestinal obstruction. A routine ante-natal ultrasound had shown dilated loops of bowel. The baby did not tolerate feeds and pass meconium rather developed progressive abdominal distension and bilious vomiting. Abdominal X-ray showed dilated bowel loops. A contrast enema showed micro colon and cut off sign at splenic flexure (Fig. 1). Our preoperative diagnosis was colonic atresia. After resuscitation and optimization, operation was performed that revealed concomitant type I jejunoileal and transverse colon atresias (Fig. 2,3). After excision of 10 cm of dilated proximal jejunum, an end-to-oblique jejunojejunal anastomosis was performed; divided colostomy was done at the level of colonic atresia. Post operative course was uneventful. Patient was discharged on 8th post operative day. The patient had a rectal biopsy done at 6th week follow-up. Biopsy showed presence of normal ganglion cells. Appointment was given for colostomy reversal.

Barnard and Louw put forward vascular incidents as a probable etiology of intestinal atresias based upon their experiments on dog foetuses [3]. Nevertheless, failure of recanalization resulting in luminal mucosal webs in the jejunum and transverse colon seems a valid etiology in our case. Neonates with intestinal atresia present with a range of symptoms typical of intestinal obstruction. Contrast study showing a cutoff sign while transit through colon is highly suggestive of colonic atresia as documented in the index case.

Kernak et al mentioned 22 years experience on colonic atresia. They dealt 18 patients of colonic atresia while 4 were concomitant cases of jejunoileal and colonic atresia.  [4]. DallaVecchia et al mentioned their 25 years experience on intestinal atresia. Out of 277 cases, only 5 were concomitant cases of jejunoileal and colonic atresia [5].

The surgical options as to concomitant jejunoileal and colonic atresias largely depend upon level of jejunoileal and colonic atresias. A primary anastomosis for jejunoileal atresias and a colostomy for colonic atresia is an acceptable option for proximal small bowel atresias. Ileostomy for distal ileal atresia and primary colocolic anastomosis is another option [4]. End ileostomy, Jejunocolic and ileocolic anastomosis are other options depending upon the length of bowel between both atresias.

 


Figure 1: Microcolon

 

Figure 2: Type-I jejunal atresia

 

Figure 3: Type-I colonic atresia

 



REFERENCES

  1. Ameh EA, Chirdan LB. Neonatal intestinal obstruction in Zaria, Nigeria. East Afr Med J. 2000; 77:510–13.

  2. Cox SG, Numanoglu A, Millar AGW, Rode H. Colonic atresia: spectrum of presentation and pitfalls in management. A review of 14 cases. Pediatr Surg Int. 2005; 21: 813–8.

  3. Louw JH, Barnard CN. Congenital intestinal atresia; observations on its     origin. Lancet. 1955; 269:1065-7.

  4. Karnak I, Ciftci OA, Senocak ME, Tanyel FC, Buukpamukcu N. Colonic atresia: surgical management and outcome. Pediatre Surg Int. 2001; 17: 631-5.

  5. Dalla Vecchia LK, Grosfeld JL, Karen WW, Frederick JR, Scherer LR, Scott AE. Intestinal atresia and stenosis, A 25-year experience with 277 cases. Arch Surg. 1998; 133:490-7.

 


This is an Open Access article distributed under the terms of the Creative Commons Attribution unported License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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