Congenital intestinal atresia is one of the common gastrointestinal malformations in neonatal surgery, with a high incidence of about 1:5000, slightly higher in males than females. In the last decade, with the improvement of surgical techniques and the rapid improvement of perioperative monitoring and treatment, the survival rate has increased significantly.
Causes
There is no definite final conclusion on the etiology of the disease. In addition to the analysis of the possible etiology of microscopic aspects, air pollution, harmful food additives, intrauterine viral infections and other possible etiologies.
Clinical manifestations
The clinical manifestations are typical of intestinal obstruction, with vomiting, abdominal distension and abnormal defecation after birth. The early appearance and degree of symptoms are directly related to the location of atresia. Frequent vomiting can lead to dehydration and aspiration pneumonia, and long delay is bound to cause intestinal perforation, peritonitis and sepsis, and the condition will deteriorate rapidly and eventually death.
Diagnosis and differentiation
Auxiliary examination
1, abdominal x-ray standing plain film: routine examination, can initially determine the site of atresia, the severity of the lesion and the possible prognosis.
2. Gastrointestinal imaging: an examination means that may cause radiation damage, and is still widely used in small and medium-sized cities and non-specialized hospitals with relatively low medical standards. The imaging examination can clearly diagnose the site of the lesion and has important significance for the related differential diagnosis.
3, abdominal ultrasonography: ultrasonography has developed rapidly in recent years and has partially or even completely replaced the diagnostic functions of traditional imaging, tomography and other large auxiliary instruments. Ultrasonography is a simple method, low equipment requirements, objective and harmless to the body, but requires that the ultrasonographer should have extensive clinical experience and certain specialized skills in surgical anatomy.
Disease diagnosis
Excessive amniotic fluid and abnormal fetal movement in mothers at the end of pregnancy should be given sufficient attention, and prenatal ultrasonography can usually indicate suspicious lesions. Referring to the results of prenatal ultrasonography and the obvious surgical signs after birth, combined with the typical symptoms of vomiting, inability to feed, abdominal distention and absence of normal fetal stool outflow after birth, most of the diagnosis can be clarified by the necessary auxiliary examinations such as standing abdominal plain film, abdominal ultrasonography and gastrointestinal imaging.
Differential diagnosis
There are relatively few other diseases with typical symptoms similar to congenital intestinal atresia, which should be differentiated from functional abdominal distension and vomiting in internal medicine. In addition, abdominal distension and vomiting caused by some inherited metabolic diseases also need to be distinguished. Complete and mechanical intestinal obstruction due to various causes such as congenital total colon and congenital intestinal stenosis can also cause similar clinical manifestations to this disease and need to be distinguished.
Treatment
Once the diagnosis of intestinal atresia is established, surgery should be performed as soon as possible to ensure safety, otherwise it may lead to intestinal perforation and eventually peritonitis, infectious toxic shock and death from multiple organ failure.
There are many surgical methods and approaches commonly used at home and abroad, but the ultimate goal is to reconstruct the digestive tract and restore the patency of the intestine. Combined with the specific situation in China (such as affordability, traditional thinking, etc.), the principle of surgery is as much as possible one-time surgical radical treatment.
1.Intestinal resection and anastomosis: The intestinal canal where the atretic lesion is located is resected during surgery, and the proximal end of atresia is resected appropriately according to the degree of dilatation and the thickness and elasticity of the intestinal wall, usually the resection length is about 10-20 cm, and the severed end is performed as end-to-end anastomosis, end-to-back anastomosis or long oblique anastomosis, etc. Some doctors are used to trim the proximal intestinal canal of atresia to reduce its diameter before performing end-to-end anastomosis.
2, a phase of enterostomy: atresia distal intestinal tube dysplasia, there may be functional disorders: such as fetal fecal peritonitis caused by intestinal atresia; distal ileum, colonic atresia caused by fetal colon changes and other cases should be staged surgery, a phase of enterostomy location should be carefully selected to avoid postoperative diarrhea dehydration and electrolyte disorders, usually about 3 months after fistula surgery again to close the fistula.
3, a phase of external intestinal placement: for higher location of atresia, intestinal perforation, other organ system complications, critical condition and other patients, patients who can not afford a one-time radical surgery or a phase of anastomosis surgery is too risky, should be decisively performed external intestinal placement, in order to shorten the operation time, reduce the surgical blow, avoid surgical contamination, first to save lives. After the postoperative condition is stabilized, re-operation within 3-7 days for intestinal anastomosis or formal enterostomy.
4, intestinal resection “d” anastomosis: surgery found that the patient’s own intestinal conditions are not good, the surgeon is not sure about the first-phase anastomosis, suspicious of postoperative anastomotic fistula or anastomotic severe stenosis, you can use the “d” anastomosis, general high In general, the “inverted d” anastomosis is used for high atresia, and the abdominal wall fistula can be placed to drain the dilated proximal intestinal tube to reduce the pressure in the intestinal cavity and ensure the healing environment of the anastomosis, as well as to provide enteral nutrition through fistula intubation;
Low atresia is suitable for “orthodontic” anastomosis, which can partially replace the function of enterostomy without causing serious abdominal distension once the anastomosis is narrowed or the distal intestine of atresia is dysfunctional. The “ding” anastomosis can be closed electively after satisfactory recovery of the disease, and the fistula can be closed electively if necessary without preservation of the fistula, usually in a period of 1-3 months.
Prognosis of the disease
The majority of patients have a satisfactory prognosis, and after a short recovery period, they can have normal milk intake, weight gain, and growth at the level of normal children of the same age.
A small number of patients may have surgical anastomotic stenosis, postoperative vomiting of varying degrees, weight gain or even weight loss, chronic dehydration and electrolyte disorders may occur if symptoms persist for a long time, and growth and development may be seriously affected.
Patients with intestinal atresia have a slow recovery of intestinal function compared to other GI surgeries, and it takes at least 1-2 months to fully recover. Nutrition.
Patients with congenital intestinal atresia are early, young, low weight, delicate tissues and organs, the surgery is delicate and difficult, and the technical requirements of the surgeon are very high.