Apple-Peel intestinal atresia: A systematic review

Francesco Laconi; Charline Bischoff; Theo Michailos; Ongoly Okiemy M'Inserret; Emmanuelle Kremer; Marie-Laurence Poli-Merol

doi:10.47338/jns.v13.1255

Authors

Francesco Laconi Department of Pediatric Surgery, Centre Hospitalier Universitaire de Reims (CHU de Reims)
Charline Bischoff Department of Pediatric Surgery, Centre Hospitalier Universitaire de Reims (CHU de Reims)
Theo Michailos Department of Pediatric Surgery, Centre Hospitalier Universitaire de Reims (CHU de Reims)
Ongoly Okiemy M'Inserret Department of Pediatric Surgery, Centre Hospitalier Universitaire de Reims (CHU de Reims)
Emmanuelle Kremer University Medical Library, Université de Reims et Champagne Ardenne, Reims
Marie-Laurence Poli-Merol Department of Pediatric Surgery, Centre Hospitalier Universitaire de Reims (CHU de Reims)

DOI:

https://doi.org/10.47338/jns.v13.1255

Keywords:

Apple peel atresia, Intervention, Primary resection, Complications, Neonate

Abstract

Background: Apple-peel bowel atresia (APA) is rare and thus lacks proper management guidelines. This systematic review analyzes various interventions found in the literature for this type of atresia and highlights the outcomes of each intervention with their complications.

Methods: The relevant literature on PubMed, Scopus, Embase, and Cochrane was reviewed from November 2020 to January 2021. Articles published in English, French, Italian, or Spanish between 1990 and 2020, focusing on APA, were included. Data on demography, clinical profile, management provided, time to achieve full feed, length of hospital stay, complications, etc., reviewed.

Results: A total of 2495 articles were found, of which only 48 met the inclusion criteria. Among these, 125 patients were treated, with 15 deaths. The most frequently employed intervention was primary resection, with or without tapering, while ostomy creation was less commonly used. The most frequent complication across all techniques appeared to be cholestasis, followed by stenosis of the anastomosis and sepsis. Additionally, there were a total of 7 cases of short bowel syndrome (SBS).

Conclusion: The management of apple-peel atresia seems variable in various centers of different countries. The review failed to assess which interventions could lead to faster full enteral feeding. The distal part of the anastomosis must be considered as an active part in the resumption of bowel function.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

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

Moola S, Munn Z, Tufanaru C, et al. Checklist for Case Reports. Joanna Briggs Inst Crit Appraisal tools. 2016:1-4.

Zvizdic Z, Popovic N, Milisic E, Mesic A, Vranic S. Apple-peel jejunal atresia associated with multiple ileal atresias in a preterm newborn: A rare congenital anomaly. J Paediatr Child Health. 2020;56(11):1814-6. doi:10.1111/jpc.14793.

Burjonrappa SC, Crete E, Bouchard S. Prognostic factors in jejuno-ileal atresia. Pediatr Surg Int. 2009;25(9):795-8. doi:10.1007/s00383-009-2422-y.

Kirtane JM, Bhange SA, Nabi F, Shah V. Duodenal atresia with familial apple peel syndrome: Case study with review of literature. BMJ Case Rep. 2019;12(8). doi:10.1136/bcr-2019-230160.

De Grazia E, Di Pace MR, Caruso AM, Catalano P, Cimador M. Different types of intestinal atresia in identical twins. J Pediatr Surg. 2008;43(12):2301-4.

Strømme P, Dahl E, Flage T, Stene-Johansen H. Apple peel intestinal atresia in siblings with ocular anomalies and microcephaly. Clin Genet. 1993;44(4):208-10. doi:10.1111/j.1399-0004.1993.tb03881.x.

Herman TE, Siegel MJ. Apple peel small bowel. J Perinatol. 2008;28(5):380-2. doi:10.1038/sj.jp.7211922.

van Bever Y, van Hest L, Wolfs R, et al. Exclusion of a PAX6, FOXC1, PITX2, and MYCN Mutation in Another Patient With Apple Peel Intestinal Atresia, Ocular Anomalies and Microcephaly and Review of the Literature. Am J Med Genet Part A. 2008;146A:500–4.

Tatekawa Y, Kanehiro H, Nakajima Y. Duodenal atresia associated with “apple peel” small bowel without deletion of fibroblast growth factor-10 or fibroblast growth factor receptor 2IIIb: Report of a case. Surg Today. 2007;37(5):430-3. doi:10.1007/s00595-006-3415-2.

Digilio MC, Magliozzi M, Di Pede A, et al. Familial aggregation of “apple peel” intestinal atresia and cardiac left-sided obstructive lesions: A possible causal relationship with NOTCH1 gene mutations. Am J Med Genet Part A. 2019;179(8):1570-4. doi:10.1002/ajmg.a.61195.

Dewberry LC, Hilton SA, Vuille-dit-Bille RN, Liechty KW. Is Tapering Enteroplasty an Alternative to Resection of Dilated Bowel in Small Intestinal Atresia? J Surg Res. 2020;246:1-5. doi:10.1016/j.jss.2019.08.014.

Ozguner IF, Savas C, Ozguner M, Candir O. Intestinal atresia with segmental musculature and neural defect. J Pediatr Surg. 2005;40(8):1232-7. doi:10.1016/j.jpedsurg.2005.05.032.

Saha H, Halder A, Chatterjee U, et al. Clinicopathological study of intestinal smooth muscles, interstitial cells of Cajal and enteric neurons in neonatal jejunoileal atresia with special reference to muscle morphology. J Pediatr Surg. doi:10.1016/j.jpedsurg.2019.06.003.

Festen S, Brevoord JCD, Goldhoorn GA, et al. Excellent long-term outcome for survivors of apple peel atresia. J Pediatr Surg. 2002;37(1):61-5. doi: 10.1053/jpsu.2002.29428.

DeLorimier AA, Fonkalsrud EW, Hays DM. Congenital atresia of the jejunum and ileum. Surgery. 1969;65:819-27.

Mangray H, Ghimenton F, Aldous C. Jejuno-ileal atresia: its characteristics and peculiarities concerning apple peel atresia, focused on its treatment and outcomes as experienced in one of the leading South African academic centres. Pediatr Surg Int. 2020;36(2):201-7. doi: 10.1007/s00383-019-04594-y.

Zhu H, Gao R, Alganabi M, et al. Long-term surgical outcomes of apple-peel atresia. J Pediatr Surg. 2019;54(12):2503-8. doi:10.1016/j.jpedsurg.2019.08.045.

Joda AE, Abdullah AF. Outcomes of end to side oblique anastomosis as a surgical technique for jejuno-ileal atresia. Updates in Surgery. 2019. doi:10.1007/s13304-019-00666-9.

Gutierrez IM, Kang KH, Jaksic T. Neonatal short bowel syndrome. Semin Fetal Neonatal Med. 2011;16:157-63.

Hillyer MM, Baxter KJ, Clifton MS, et al. Primary versus secondary anastomosis in intestinal atresia. J Pediatr Surg. 2019;54(3):417-22. doi:10.1016/j.jpedsurg.2018.05.003.

Ito Y, Asato K, Cho I, et al. Intestinal flow after anastomotic operations in neonates. Computers in Biology and Medicine. 2020;118:103471. doi: 10.1016/j.compbiomed.2019.103471.

Sinnott MD, Cleary PW, Harrison SM. Peristaltic transport of a particulate suspension in the small intestine. Appl Math Modell. 2017;44:143-59. doi: 10.1016/j.apm.2017.01.034.