2.8 Management of patients with dissection of the descending thoracic aorta — A comparative study between closing and non-closing dissections

Abstract

This report describes the individualized operative therapy in 75 patients with intestinal atresia or stenosis based on pathological findings (1972–1978). Location of obstruction was duodenal in 30, jejunoileal in 38, and colonic in 7. Duodenal atresia was noted in 23 infants and stenosis in 7. Associated anomalies were observed in 23 patients, prematurity in 11, polyhydramnios in 11, and Down's Syndrome in 10. Operative treatment included duodenoduodenostomy (DD) in 19 patients, duodenotomy and web excision in 9, and side-to-side duodenojejunostomy (DJ) in 2. Both (DJ) cases needed revision to (DD) because of obstruction. A gastrostomy was used in all cases. Jejunoileal atresia occurred in 33 patients and stenosis in 5. Operations included wide proximal resection and endto-end anastomosis in 18 patients with normal bowel length, minimal resection with antimesenteric tapering enteroplasty (using autostaples) and anastomosis in 9 patients with foreshortened bowel, and resection and double barrel enterostomy in 6 with peritonitis or questionable bowel viability. Seventy percent received total parenteral nutrition (TPN). Six patients with colon atresia and one infant with stricture of the rectosigmoid survived initial colostomy and subsequent anastomosis at 3 to 6 mo of age. Survival for duodenal cases was 84%, jejunoileal 90%, and colonic 100%. Individualizing the operative management according to pathologic findings and TPN support when indicated improve operative survival in infants with intestinal atresia.