Critical Care Medicine
Gastrointestinal Emergencies: Intestinal Atresia (esophageal, pyloric, duodenal, jejunal, ileal)
Also known as: Intestinal Atresia (Esophageal, Duodenal, Jejunal, Ileal)
Related conditions: Esophageal Atresia, Duodenal Atresia, Jejunal Atresia, Ileal Atresia
1. Description of the problem
Intestinal atresia refers to a complete obstruction of a hollow viscus lumen and can occur at any location in the GI tract. It may be diagnosed prenatally on ultrasound, depending on the degree of obstruction and the gestational age at imaging.
Clinical symptoms of intestinal atresia depend primarily on location of the atresia. If not a complete obstruction, symptoms may be delayed. Typical symptoms include:
Non-bilious vomiting in newborn period
Inability to feed
Vomiting - may be bilious
Abdominal distention - the more distal the lesion, the more distended the abdomen
Vomiting - may be bilious
2. Emergency Management
Stabilize the newborn.
Evaluate for intestinal atresia and associations with abdominal and other radiographs, consider contrast study.
Surgical management for atresia.
The diagnosis of intestinal atresia includes both physical exam as well as radiographic studies with a focus on diagnosis and identification of associated abnormalities. Often in addition to plain films a contrast study may be necessary.
Esophageal atresia: Nasogastric tube unable to be passed and visualized at esophageal atresia site on abdominal x-ray
Associations: Tracheoesophageal fistula (TEF), VACTERL abnormalities (vertebral, anal, tracheoesophageal, renal, cardiac, limb defects).
Duodenal atresia: "Double bubble" on abdominal x-ray
Associations: Biliary atresia, agenesis of gall bladder, cardiac malformations, renal malformations, vertebral malformations, trisomy 21
Jejunal / Ileal atresia: Dilated loops of the small bowel with air-fluid levels
Associations: Cystic fibrosis, meconium ileus, microcolon.
Intestinal atresia is often diagnosed prenatally. The incidence is unknown but the most common site of intestinal atresia is the jejunum/ileum, with approximately 1 in 5,000 births; duodenal atresia incidence is approximately 1 in 30,000 births, with a third associated with Down syndrome. The etiology of intestinal atresia is unknown but is believed to be heterogeneous, including a vascular event and/or abnormal epithelial-mesenchymal interactions.
Outcome of intestinal atresia is excellent following surgical repair and typically depends on associated medical conditions or other congenital abnormalities.
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