Type III colonic atresia in a 6-week-old kitten.

Case series summary: A 6-week-old intact male domestic shorthair kitten presented for abdominal distension, small stature, vomiting and inappetence. Abdominal radiographs showed marked generalized gaseous gastrointestinal dilation. Exploratory laparotomy revealed type III colonic atresia which was surgically corrected via jejunocolic anastomosis. The kitten survived the immediate postoperative period and was discharged from the hospital but subsequently declined and was euthanized 7 days after surgery. Relevance and novel information: The patient described in this report is a rare case of colonic atresia diagnosed in the postneonatal period. To our knowledge, this is the first ante-mortem case diagnosed with type III colonic atresia and description of surgical management reported in companion animal medicine. The patient had short-term survival after surgery that, with adjustments to the postoperative care, may result in long-term survival for future patients.

Colonic Atresia Associated with Biliary Atresia.

Colonic atresia (CA) is an uncommon type of intestinal atresia commonly associated with other anomalies, while biliary atresia (BA) is also rare but usually an isolated anomaly. The pathogenesis for either of the anomalies is unclear. The co-occurrence of both pathologies has not been mentioned in the literature. We here discuss the management of CA with BA and the review of pertinent literature.

Windsock or Cobra Head Sign: A Distinctive Imaging Sign to Differentiate Type 1 Colonic Atresia From Hirschsprung's Disease.

Colonic atresia is a rare cause of congenital low-type intestinal obstruction in the neonatal age group and may present as a surgical emergency if not diagnosed early. Clinically, it can pose a diagnostic dilemma for Hirschsprung disease, which involves a different treatment strategy. Therefore, an early and accurate diagnosis is paramount from a management and prognosis perspective. The contrast enema plays a crucial role in the diagnosis of the disease. The "Windsock or Cobra head sign" on the contrast enema, typically seen only in type 1 colonic atresia, can help radiologists and surgeons identify this disease. We report a case of a two-day-old neonate, including a clinical feature of low-grade intestinal obstruction with distinctive imaging signs of type 1 colonic atresia, which can help make a definitive diagnosis.

Congenital Segmental Dilatation of Ascending Colon with Distal Microcolon: A Diagnostic Dilemma.

A 5-day-old male presented with bilious vomiting, a grossly distended abdomen, and passage of a small amount of stool. The anal opening was at a normal position. X-ray abdomen showed a large bowel loop with a single air-fluid level occupying more than half of the abdominal width. On laparotomy, the ascending colon was dilated to form a pouch-like structure, and the ileum and appendix were opening into it. Colon distal to pouch was present as microcolon. Histopathology of the dilated segment was suggestive of congenital segmental dilatation (CSD). In CSD, the distal bowel is of normal caliber. This is a rare case of CSD of ascending colon with distal microcolon.

Intestinal atresia and necrotizing enterocolitis: Embryology and anatomy.

The primitive gut originates at week 3 of gestation from the endoderm, with posterior incorporation of the remaining embryo layers. Wnt, Notch and TLR4 pathways have been shown to play central roles in the correct development of the intestine. The classical hypothesis for intestinal atresia development consists of failure in bowel recanalization or a vascular accident with secondary bowel reabsorption. These have been challenged due to the high frequency of associated malformations, and furthermore, with the discovery of molecular pathways and genes involved in bowel formation and correlated defects producing atresia. Necrotizing enterocolitis (NEC) has a multifactorial pathogenesis with prematurity being the most important risk factor; therefore, bowel immaturity plays a central role in NEC. Some of the same molecular pathways involved in gut maturation have been found to correlate with the predisposition of the immature bowel to develop the pathological findings seen in NEC.

Staged Repair Using Modified Bishop-Koop Procedure in Complicated Congenital Colonic Atresia in a Neonate.

Colonic atresia (CA) is the rarest type of intestinal atresia and is defined as an obstruction in the large intestinal lumen. This is a rare case presentation of a four-day-old full-term female patient presented with signs and symptoms of intestinal obstruction. Investigation revealed that she had complicated CA located in the splenic flexure. Laparotomy and colostomy were done on the patient. About two months later, she was admitted for stoma closure, which was converted to modified Bishop-Koop stoma. Lastly, the patient underwent a successful stoma closure. Upon one month of follow-up, the patient's condition has markedly improved and the wound healed well without any complications.

Anorectal malformation, associated with colon atresia and intestinal malrotation, a case report.

INTRODUCTION AND IMPORTANCE: In this case report from Muhimbili National Hospital, Dar es salaam, Tanzania, we present the unexpected findings of anorectal malformation, colonic atresia, and intestinal malrotation in a 2-day old neonate. This combination is exceedingly rare, with only case reports published in the literature. We describe the challenges in diagnosis and offer our insights based on this experience and review of the literature. CASE PRESENTATION: Our patient was a male born at term, weighing 2600 g, diagnosed clinically with a high anorectal malformation. He was planned for colostomy, and we unexpectedly found a collapsed descending colon. Exploration revealed intestinal malrotation and three segments of type I colonic atresia from the mid transverse colon to the sigmoid colon in addition to the high anorectal malformation. CLINICAL DISCUSSION: Creating a colostomy in a high anorectal malformation and failure to identify proximal intestinal atresia would result in potentially devastating consequences. Colonic atresia and anorectal malformation will both present as large bowel obstruction. In the extremely rare situation, when occurring in combination, the obvious clinical diagnosis of anorectal malformation will mask the clinical suspicion of the possibility of colonic atresia. Finding a distal bowel air bubble above the pubococcygeal line on an invertogram is useful in identifying proximal atresia preoperatively. CONCLUSION: The current report emphasizes the importance of maintaining an awareness of possible associated colonic atresia in neonates with anorectal malformation. An invertogram and intraoperative finding of a collapsed descending colon should prompt evaluation for a proximal obstructing lesion.

Colonic atresia: a rare entity in the newborn. A six-case report and a bibliographic review. / Atresia de colon, una entidad poco frecuente en el recién nacido. A propósito de seis casos y revisión bibliográfica.

INTRODUCTION: Colonic atresia is a rare malformation accounting for 1.8-15% of all intestinal atresias. We present a 6-case series along with a bibliographic review. CLINICAL CASE: This 6-case series consists of three female cases and three male cases diagnosed 24-84 hours following birth. They were all located in the right hemicolon. The most relevant clinical signs included abdominal distension, absence of defecation, and bilious to fecal vomit. Repairs included primary or step-by-step anastomoses for bowel transit reconstruction. One patient diagnosed at > 72 hours of life died. CONCLUSION: In our experience with colonic atresia, when primary or step-by-step intestinal recanalization (diversion for future repair) is achieved, the expected prognosis is excellent, provided that colonic atresia has been diagnosed at 24-48 hours of life.

INTRODUCCION: Las atresias de colon son malformaciones raras que comprenden alrededor de 1,8-15% de total de las atresias intestinales. Presentamos una serie de seis casos junto con una revisión bibliográfica. CASO CLINICO: Esta serie de casos incluye tres casos femeninos y tres casos masculinos que fueron diagnosticados entre 24-84 horas del nacimiento. Todas se localizaron en el hemicolon derecho. Las manifestaciones clínicas más relevantes fueron distensión abdominal, ausencia de evacuaciones, vómitos de biliosos a fecaloideos. Las correcciones incluyen anastomosis primarias o por etapas para la reconstrucción del tránsito intestinal. Se presentó una defunción en un paciente diagnosticado con > 72 horas de vida. CONCLUSION: En nuestra experiencia, en la atresia de colon, cuando se logra recanalizar el intestino de forma primaria o por etapas (derivación para la futura corrección), se espera excelente pronóstico, siempre que sea diagnosticada entre las 24 a 48 horas de vida.

Atresia de colon, una entidad poco frecuente en el recién nacido. A propósito de seis casos y revisión bibliográfica / Colonic atresia: a rare entity in the newborn. A 6-case report and a bibliographic review

Introducción: Las atresias de colon son malformaciones raras quecomprenden alrededor de 1,8-15% de total de las atresias intestinales.Presentamos una serie de seis casos junto con una revisión bibliográfica. Caso clínico: Esta serie de casos incluye tres casos femeninos ytres casos masculinos que fueron diagnosticados entre 24-84 horas delnacimiento. Todas se localizaron en el hemicolon derecho. Las manifestaciones clínicas más relevantes fueron distensión abdominal, ausencia de evacuaciones, vómitos de biliosos a fecaloideos. Las correccionesincluyen anastomosis primarias o por etapas para la reconstrucción deltránsito intestinal. Se presentó una defunción en un paciente diagnosticado con > 72 horas de vida. Conclusión: En nuestra experiencia, en la atresia de colon, cuandose logra recanalizar el intestino de forma primaria o por etapas (deriva-ción para la futura corrección), se espera excelente pronóstico, siempreque sea diagnosticada entre las 24 a 48 horas de vida.(AU)

Introduction: Colonic atresia is a rare malformation accountingfor 1.8-15% of all intestinal atresias. We present a 6-case series alongwith a bibliographic review.Clinical case: This 6-case series consists of three female cases andthree male cases diagnosed 24-84 hours following birth. They were alllocated in the right hemicolon. The most relevant clinical signs includedabdominal distension, absence of defecation, and bilious to fecal vomit.Repairs included primary or step-by-step anastomoses for bowel transitreconstruction. One patient diagnosed at > 72 hours of life died.Conclusion: In our experience with colonic atresia, when primaryor step-by-step intestinal recanalization (diversion for future repair) isachieved, the expected prognosis is excellent, provided that colonicatresia has been diagnosed at 24-48 hours of life.(AU)

Congenital multiple colonic atresias with intestinal malrotation: a case report.

BACKGROUND: Congenital intestinal atresia develops in 1 in 1500 to 20,000 births. Colonic atresia, which accounts for 1.8-15% of intestinal atresia cases, is accompanied by other gastrointestinal atresias such as small intestinal atresia, gastroschisis, imperforate anus, and intestinal malformation in 47-80%. Although a report shows that patients with multiple colonic atresias are 8.9% of those with colonic atresia. CASE PRESENTATION: A male infant did not have the first bowel movement within 36 h of birth and had abdominal distention/vomiting. Radiography showed significant dilation of the intestinal tract. A contrast enema examination at 3 days of age showed a microcolon and disruption in the descending colon. We performed an emergency decompressive loop enterostomy in the distended segment. At the age of 7 months, imaging from the stoma showed disruption of the contrast medium in the intestinal tract at the right lower abdomen, and the continuity of the intestinal tract was not clarified. Intestinal malrotation was found during the second surgery, and the enterostomy was located in the ileum proximal to Bauhin's valve. Continuity of the intestinal serosal surface was maintained. However, multiple membranous obstructions (three atresias and one stenosis) were observed in the distal segment of the bowel, which was penetrated by intraluminal advancement of a urethral catheter. Therefore, he was diagnosed with multiple colonic atresias. The intestinal tract was longitudinally incised, and membranectomy and mucosal/lateral suture were performed. CONCLUSIONS: It is important for neonates with intestinal atresia to evaluate and prepare for distal patency of the colon before radical anastomosis. In addition, anomalies associated with colon atresia should also be assessed.

Early diagnosis and surgical intervention untie the Gordian knot in newborns with colonic atresia: report of two cases and review of the literature.

Incidence of colonic atresia in living infants ranges from 1:5,000 to 1:60,000 (average 1:20,000). It constitutes 1.8 to 15% of all cases of atresia of the gastrointestinal tract. In 58.56-75% of all cases is right-sided. We aim, through the presentation of two cases of colonic atresia which we encountered and after systematic research of the current literature, at addressing three major issues: diagnostic approach, operative strategy and management of the prognostic parameters of the colonic atresia. The common parameter in these two cases was the early diagnosis, which played a significant role in the uncomplicated postoperative course. The first case was a type I sigmoid atresia. Contrast's escape during contrast enema examination due to accidental rupture of the distal part of the colon led to diagnosis. Side-to-side anastomosis, restoration of the rupture and a central loop sigmoidostomy were urgently performed. The second case was a type III atresia at the level of the ascending colon, which was early diagnosed via pregenital ultrasonography, in which colonic dilation was depicted. Restoration of the intestinal continuity early after birth was performed at a time. In conclusion, we believe that early diagnosis, selection of the appropriate operative strategy and prompt recognition of potential post-operative complications, especially rupture of the anastomosis, contribute to the optimization of the prognosis in patients with colonic atresia.

Demographic Study and Management of Colonic Atresia: Single-Center Experience with Review of Literature.

CONTEXT AND AIM: The aim of this study is to highlight the rarity of this disorder and its associated anomalies and our objective was to review our experience in the management of colonic atresia (CA) with respect to staged surgery versus one-step procedure for a better outcome of the disease. SETTINGS AND DESIGN: A randomized, controlled, single-center study conducted over a period of 4 years from October 2013 to 2017. SUBJECTS AND METHODS: Nine cases were operated for CA of which three underwent primary anastomosis and six underwent initial colostomy followed by definitive surgery. Age, sex, body weight, clinical presentation, type of atresia, site, time interval of operation, associated anomalies, initial procedure, postoperative complications, final procedure, biopsy, hospital stay, and outcome were noted. STATISTICAL ANALYSIS USED: Microsoft Excel was used for statistical analysis. RESULTS: Out of 9 patients, 6 were males and 3 were females, 7 patients survived and 2 patients died (mortality 22.2%), of which one patient with primary anastomosis had leak and sepsis and one patient with primary anastomosis had associated Hirschsprung's disease (HD). Mean time gap for operation was 12.8 h and mean hospital stay was 3.5 days for initial colostomy and 21 days for primary anastomosis. Wound dehiscence occurred in 4 patients. Malrotation was found in 3 patients, HD in 2 patients, cardiac anomaly in 2, Meckel's diverticulum in 1, and cleft lip in 1 patient. Type IIIa atresia was found in in 6 patients, Type I in 2, and Type II in 1 patient. The most common site was transverse colon (n = 5). CONCLUSION: Diagnosis and management of CA is a challenge. Early presentation and diagnosis should be prompt. Staged procedure with initial colostomy followed by definitive procedure is the preferred choice. Associated anomaly HD must be ruled out.

Maternal report of fever from cold or flu during early pregnancy and the risk for noncardiac birth defects, National Birth Defects Prevention Study, 1997-2011.

BACKGROUND: As maternal fever affects approximately 6-8% of early pregnancies, it is important to expand upon previous observations of an association between maternal fever and birth defects. METHODS: We analyzed data from the National Birth Defects Prevention Study, a multistate, case-control study of major structural birth defects. Telephone interviews were completed by mothers of cases (n = 17,162) and controls (n = 10,127). Using multivariable logistic regression, we assessed the association between maternal self-report of cold or flu with fever and cold or flu without fever during early pregnancy and 30 categories of non-cardiac birth defects. RESULTS: Maternal report of cold or flu with fever was significantly associated with 8 birth defects (anencephaly, spina bifida, encephalocele, cleft lip with or without cleft palate, colonic atresia/stenosis, bilateral renal agenesis/hypoplasia, limb reduction defects, and gastroschisis) with elevated adjusted odds ratios ranging from 1.2 to 3.7. Maternal report of cold or flu without fever was not associated with any of the birth defects studied. CONCLUSIONS: This study adds to the evidence that maternal fever during early pregnancy is associated with an increased risk for selected birth defects. Elevated associations were limited to mothers who reported a fever, suggesting that it is fever that contributes to the excess risk rather than illnesses associated with it. However, fever may also serve as a marker for more severe infections.

Role of intraluminal bowel echogenicity on prenatal ultrasounds to determine the anatomical level of intestinal atresia.

OBJECTIVE: To evaluate the correlation between different degrees of bowel intraluminal echogenicity showed by prenatal ultrasounds and the anatomic level of intestinal atresia. METHODS: We report three cases of intestinal atresia at different intestinal levels verified during the neonatal surgery with specific ultrasonographic prenatal features. Intensity of sonolucency was analyzed using the image-processing program ImageJ for quantitative measurements based on the gray-scale intensity values. RESULTS: A total of three cases are reported, a jejunal, an ileal and a colonic atresia. All cases showed intestinal dilatation. Both, jejunal and ileal atresia, showed two degrees of hypoechoic intestinal content, while colonic atresia showed hyperechogenic content dilated loop at prenatal ultrasound scan. CONCLUSIONS: We propose the use of prenatal ultrasounds echogenicity of intestinal dilated loop fluid content to help in determining the level of obstruction in bowel atresia. These are initial results, to be confirmed by a multicentric research with more cases.

Colonic Atresia: Association with Other Anomalies.

BACKGROUND: Colonic atresia (CA) is a rare form of congenital intestinal atresia. Although CA may be isolated, it is more commonly reported in literature in association with other congenital anomalies. MATERIALS AND METHODS: This study is a review of prospectively collected data of all the patients with colonic atresia presented to our center (Ain Shams University) during 2008 to 2016. RESULTS: Twelve patients were enrolled in this study. The atresia was of type I in one case, type II in four cases, type IIIa in six cases, type IV in one case. These cases accounted for 4.9 % of intestinal atresias managed in our center during the same period. Five cases were isolated CA, while the other seven cases had associated abdominal congenital anomalies (exomphalos, Hirschsprung's disease, imperforate anus, closing gastroschisis, colonic duplication, and multiple small bowel atresia in two cases). The management in ten cases was by staged procedure with creation of a temporary stoma initially, while primary anastomosis was established in two cases. We had two cases with delayed presentations, one missed diagnosis, and three mortalities in this series. CONCLUSIONS: The low incidence of CA may result in delay in the diagnosis and management. Hirschsprung's disease should be excluded in every case of colonic atresia. Early diagnosis and proper surgical management is essential for good prognosis.

Colonic atresia associated with annular pancreas: An extremely rare and previously unreported association.

Colonic atresia is the rarest entity among the all intestinal atresias and may be associated with anterior abdominal wall defect, small intestinal atresia, Hirschsprung's disease, and other anomalies. Here, we are reporting a case of colonic atresia associated with annular pancreas, which has not been reported previously to the best of our knowledge.

Malrotation and intestinal atresias.

This review encompasses four congenital conditions which present with symptoms of bowel obstruction in the neonatal period. The antenatal and postnatal features of malrotation, jejuno-ileal atresia, duodenal atresia and colonic atresia are discussed. Each condition is outlined including the classification, epidemiology, aetiology and presentation, and a summary of the surgical management is described.

Colonic atresia and anorectal malformation in a Haitian patient: a case study of rare diseases.

INTRODUCTION: Colonic atresia and anorectal malformation are rare congenital anomalies individually. Few reports of the conditions combined in a single patient have been published in the literature. Neither colonic atresia, anorectal malformation or a combination of the disorders has previously been reported in the Haitian population. CASE PRESENTATION: A 5-day-old female presented with feculent emesis, failure to pass stool since birth and an imperforate and stenotic anus. Exploratory laparotomy revealed colorectal atresia distal to a malformed cecum and a Wingspread low subtype anorectal malformation without any associated urogenital fistulae. Temporizing percutaneous ileal drainage was followed by second-stage anal perforation and dilation, ileal J-pouch and pull through. DISCUSSION: This is the first reported case of colonic atresia, anorectal malformation or the combination of the disorders among the Haitian population and one of only a handful of such cases reported worldwide. Although vascular accidents in utero have been implicated as the etiology of colonic atresia, simultaneous presence of anorectal malformation suggests a multifactorial cause. Investigation for multisystem abnormalities is warranted. Two-staged operative correction is considered the best treatment; however, long-term postoperative outcomes are uncertain. CONCLUSION: The coexistence of colonic atresia and anorectal malformation is a very rare occurrence and presents unique clinical and operative challenges. Investigation for additional congenital abnormalities is appropriate, and although two-stage operative correction is considered the best treatment, long-term outcomes are uncertain.

Colonic Atresia due to Internal Herniation through the Falciform Ligament Defect: A Case Report.

Colonic atresia is the rarest outcome of all gastrointestinal type of internal hernia. We report a case of neonate with atresia of the transverse colon caused by herniation of the transverse colon through a defect in falciform-ligament.