Abstract
Background and aims: Jejunoileal atresia is a frequent cause of intestinal obstruction in neonates. In our country, the socioeconomic status, lack of well equipped ambulance transfer, lack of neonatal preoperative management, this affect the relative time of presentation of neonates with this condition. For these reasons, our aim is to understand the way of management and to evaluate the surgical outcome of these procedures.
Patients and methods: 13 consecutive infants with jejunoileal atresia were included in this study from January 2007 to March 2009, to assess the relative outcome in relation to the way of management. Malrotation, Ladd’s band and previous enterostomy were not excluded. All cases will be subjected to full clinical assessment, abdominal radiography, abdominal ultrasound, routine laboratory investigations and serum electrolytes.
Results: We identified in this study 13 neonates; there were 5 females and 8 males. The mean gestational age was 37.38 weeks, the mean birth weight 2750.2 grams and 5 babies had malrotations. Eight cases had ileal atresia and 5 with jejunal atresia. On exploration, type I was found in 7 babies, type II in 3 neonates, type IIIa in one, and type IIIb in 2 cases. There were three cases referred from other hospitals ,had ileal atresia with enterostomy, 2 of them reoperated by exploration and resection of the dilated part with end to end anastomosis, while the third case presented with peritonitis due to sigmoid colon perforation, closure of the perforation with proximal protective double barrel enterostomy. This protective enterostomy was successfully closed after 3 weeks. The other five cases with ileal atresia, four of them were operated by resection of the proximal dilated nonfunctioning part (7-10 cm) and end to oblique anastomosis, the last one developed peritonitis as a result of necrotizing enterocolitis. This case was managed by resection and reanastomosis with ileostomy but died from severe septicemia. Three cases with jejunal atresia were operated by resection with end to oblique anastomosis, one of them developed anastomostic leakage and died due to bilateral pneumonia and malnourishment. The remaining 2 cases with jejunal atresia type IIIb operated by tapering enteroplasty. Ladd's band was found in five cases that was divided and released with correction of malrotation (ladd's procedure). Postoperatively, all patients had total parenteral nutrition for 4 to 30 days. The post operative follow up period varied from 3-9 months (the mean, 5 months).Postoperative complications were encountered in 7 cases (54%). The postoperative mortality was 15.4%.
Conclusion: Initial care must be given to those neonates with intestinal atresia. The primary resection and reanastomosis is the procedure of choice if it is feasible; otherwise in cases of high jejunal atresia tapering enteroplasty is recommended. On the other hand double barrel enterostomy is an alternative if primary anastomosis is risky.