Acquired Ileal Atresia in a Preterm Infant

Acquired ileal atresia is a rare but life-threatening complication that can occur after recovery from necrotizing enterocolitis in premature infants. We present an unusual case of acquired ileal atresia in the distal ileum injured by ischemia after intestinal perforation in an extremely low-birth-weight infant. A 900 g (25 weeks gestation) premature infant developed a pneumoperitoneum without the radiologic manifestations of necrotizing enterocolitis on day 9 of life. Primary peritoneal drainage without further need for surgery was performed in the neonatal intensive care facility. Gastrointestinal gastrografin studies confirmed normal intestinal continuity and regular stools. Several weeks later, while the patient was receiving all nutrition orally with no medical problems, the patient's condition suddenly deteriorated, along with clinical signs of intestinal obstruction including emesis of bilious contents and stools. Laparotomy (on day 45 of life) revealed ileal atresia with V-shaped gap mesenteric defect.

Acquired Ileal Atresia in a Preterm Infant

Acquired ileal atresia is a rare but life-threatening complication that can occur after recovery from necrotizing enterocolitis in premature infants. We present an unusual case of acquired ileal atresia in the distal ileum injured by ischemia after intestinal perforation in an extremely low-birth-weight infant. A 900 g (25 weeks gestation) premature infant developed a pneumoperitoneum without the radiologic manifestations of necrotizing enterocolitis on day 9 of life. Primary peritoneal drainage without further need for surgery was performed in the neonatal intensive care facility. Gastrointestinal gastrografin studies confirmed normal intestinal continuity and regular stools. Several weeks later, while the patient was receiving all nutrition orally with no medical problems, the patient's condition suddenly deteriorated, along with clinical signs of intestinal obstruction including emesis of bilious contents and stools. Laparotomy (on day 45 of life) revealed ileal atresia with V-shaped gap mesenteric defect.

The Experience of Operative Management in Jejunoileal Atresia

PURPOSE: Intestinal atresia is a common cause of neonatal intestinal obstruction. Recently, the survival rate has been increasing from development of prenatal diagnosis, total parenteral nutrition (TPN) and neonatal intensive care. We evaluated the complication rate and cause of mortality after operative management for jejunoileal atresia. METHODS: We reviewed 62 patients (36 males, 26 females) with jejuno-ileal atresia who underwent operation from 1998 to 2007. RESULTS: There were 37 patients with jejunal atresia and 25 with ileal atresia. The average gestational age was 256+/-16.6 days and birth weight was 2,824+/-620 g. Prenatal diagnosis was performed in 45 patients (72.6%) around gestational age 27 weeks. Within 2nd day after birth, 44 patients (71%) underwent operation. Half of the jejunoileal atresia was type IIIa and type I was in 8, type II was in 3, type IIIb was in 12, and type IV was in 8. The operative treatment was resection & anastomosis in 59 patients and enterotomy & web excision in 3. They started feeding at 12.4+/-11.5 days after operation on average. The average duration of TPN was 26.7+/-23.5 days, and the incidence of cholestasis was 30.6%. Hospital days averaged 36.8+/-26 days. Early complication occurred in 14 patients (intestinal obstruction in 5, sepsis in 4, wound problem in 3, anastomosis leakage in 1, and intraabdominal abscess in 1). Late complication occurred in 7 patients (anastomosis stricture in 4 and intestinal obstruction in 3). There was only one case of mortality due to short bowel syndrome after re-operation for adhesive ileus. CONCLUSION: The operation for intestinal atresia was successful and aggressive management contributed to a low mortality rate.

A Case of Ileal Atresia with Hypertrophic Pyloric Stenosis

Ileal atresia, a subtype of intestinal atresia, is one of the well-recognized causes of bowel obstruction in newborns. Prenatal diagnosis of intestinal atresia is very important in its management and outcome. Unfortunately, there are few cases of ileal atresia diagnosed prenatally, so more appropriate diagnoses and management plans are needed. As an associated gastrointestinal malformation with ileal atresia, hypertrophic pyloric stenosis is rarely reported. We report one case of postnatally diagnosed ileal atresia associated with hypertrophic pyloric stenosis which was complicated initially by bowel perforation and later by vomiting due to pyloric obstruction. Vomiting in the postoperative period is a common problem. But, if vomiting continues after the operation for ileal atresia, hypertrophic pyloric stenosis should be considered as a possible cause of medically retractable non-bilious vomiting.

A Case of Corpus Callosum Agenesis with Ileal Atresia and Duplication

Agenesis of corpus callosum occurs sporadically and may be transmitted as sex-linked, or autosomal-dominant or recessive traits. It has been associated with different syndromes. Clinical pictures vary from severe intellectual and neurologic abnormalities to asymptomatic and normaly intelligent cases. Agenesis of corpus callosum may occur alone, but it is more frequently associated with a high incidence of other anomalies. We report a male infant with agenesis of corpus callosum who was diagnosed to have ileal atresia and duplication.

A Case of Chylous Ascites Secondary to Congenital Ileal Atresia / 대한주산의학회잡지

Chylous ascites in neonates is an unusual and etiologically poor understood entity. We report a male newborn who suffered from abdominal distension and respiratory distress after birth. Paracentesis was performed and ascitic fluid was obstained. Analysis of the fluid revealed cell count (RBC 10,000/mm3, WBC 800/mm3: segmented form-72%, lymphocyte form- 28%), protein 4,100 mg/dl, glucose 57 mg/dl, cholesterol 53 mg/dl, triglyceride 28 mg/dl. Culture of ascitic fluid grew no bacteria. A plain film of abdomen and abdominal sonogram showed massive ascites. On the 4th hospital day, gastrografin enema showed microcolon and ileal atresia. On the 6th hospital day, ileocolostomy has been performed and operative findings sho- wed blind pouch in terminal ileum, massive inflammation and extensive adhesion on peritoneum. After operation, he gained weight by continuous gavage feeding. He discharged on the 36th hospital day.

A Successful Treatment of Ileal Atresia in A 1200 g Premature Neonate

The ileal atresia has been commonly accepted to be caused by a vascular accident during early intrauterine period. Thanks to the development of anesthesia, surgical techniques, postoperative supportive treatment and the hyperalimentation technique, the motality rate of this disease has been decreased. In spite of these developments, premature and very low birth weight babies should be given more attention because they still have a high motality rate. The authors report a successful treatment of ileal atresia in a 1,200g premature female infant. The proximal distended and hypertrophied intestine was resected. The distal small bowel was transected using a oblique line to create a fish-mouth. An end to end anastomosis was performed. We gave postoperative care, such as incubator care, fluid therapy, gastric decomprssion and total parenteral nutrition(TPN). TPN was initiated on postoperative one day. Calories were increased from 60cal/kg to 90cal/kg. TPN was stopped on the postoperative 24 day when the patient tolerated full strength milk feeding. Eighteen months postoperatively, she is healthy and her weight is 9.0kg(9 percentile).

Ileal Atresia due to Intrauterine Intussusception

The pathogenesis of intestinal atresia has shown well that mesenteric vascular insults during an intrauterine life played an important role, and it has been shown in animal experiments. Intrauterine intussusception was suggested as one of the etiologies that cause jejunoileal atresia. The aims of this study were 1) to see if polypoid lesions in congenital ileal atresia were associated with intrauterine intussusception and 2) to make diagnostic criteria for possible intrauterine intussusception. Intraluminal polypoid lesions were found in three patients with congenital ileal atresia. They were Louw classification type I in two patients, and type II in one patient. Two lesions were composed of intestinal wall layers contiguous with adjacent small bowels, however, atrophic non-viable tubular structure was found in one patient. All of this signifies that they were a remnant of an intrauterine intussusception which had occurred in a different developmental stage. In conclusion, intraluminal polypoid lesion in ileal atresia was suggested to be the remnant structure of intrauterine intussusception. Such instances were highly suggested by the followings: 1) type I or II in Louw classification 2) intraluminal polypoid lesion adjacent to atretic portion, 3) identifiable intestinal wall layers in histologic examination, 4) positive occult blood in meconium.

Ileal Atresia Complicated by Meconium Peritonitis

Meconium peritonitis is a primarily aseptic, chemical peritonitis caused by the spill of meconium into the abdominal cavity through an intestinal perforation during the intrauterine or perinatal period. The perforation is known to be related to intrauterine vascular compromise. Recently, the authors experienced 4 cases of ileal atresia complicated by meconium peritonitis. The male to female sex ratio was 1 : 3, and age at operation was 1 day(2 cases), 3 days(2 cases). Three cases had generalized peritonitis, and one the cystic type of meconium peritonitis. The types of ileal atresia were IIIa(2 cases), IIIb(1 case), and II(1 case). The proximal blind ileal end was perforated in 3 cases, and distal end perforation was in 1 case of cystic type. Postoperative recovery was excellent in all cases.

Ileal Atresia Secondary to Intrauterine Segmental Volvulus

A 2-day-old male {Premie, Large for gestational age(LGA), Intrauterine period (IUP) 33 weeks, birth weight 2,955 gram} was transferred with marked abdominal distention, bilious return via the orogastric tube, respiratory difficulty, and generalized edema (hydrops fetalis). He was born by cesarean section to a 36 year-old mother. Antenatal ultrasonogram at IUP 31 weeks demonstrated multiple dilated bowel loops suggestive of intestinal obstruction. There was no family history of cystic fibrosis. Simple abdominal films disclosed diffuse haziness and suspicious fine calcifications in the right lower quadrant. Barium enema demonstrated a microcolon. Sweat chloride test was not available in our institution. At laparotomy, there noted 1) a segmental volvulus of the small bowel with gangrenous change, associated with meconium peritonitis, 2) an atresia of the ileum at the base of the volvulus, and 3) the terminal ileum distal to the volvulus was narrow and impacted with rabbit pellets-like thick meconium. These findings appeared to be very similar to those of a complicated meconium ileus. In . summary, the ileal atresia and meconium peritonitis seemed to be caused by antenatal segmental volvulus of the small intestine in a patient with probable meconeum ileus.

Necrotizing enterocolitis after operation for ileal atresia.

NEC usually affects newborns especially low birth weight often with history of perinatal stress. It usually manifests itself within five to ten days after birth with abdominal distension, bilious vomiting and bloody diarrhea. Development of NEC after operation seldom occur. It was first reported in patients underwent open-heart surgery employing hypothermia and cardiopulmonary by-pass. Later it was found to be common among gastroschisis patients post repair of abdominal wall defect. Clinical pictures of usual case of NEC and that develop after operation are partly resemble and partly differ. NEC is rarely seen after other operative procedures especially intestinal atresia. Review of the literatures revealed only eight such cases. Our report of two cases following operation for intestinal atresia with explanation both on similar and different clinical pictures from usual of NEC.