Proximal colonic atresia: is right hemicolectomy inevitable?

Abstract

Proximal colonic atresia often results in a marked discrepancy of the atretic ends presenting a technical challenge for restoration of bowel continuity. We review our series of colonic atresia patients with particular reference to the techniques for restoring bowel continuity. Case notes of all patients diagnosed with colonic atresia and admitted to our unit between 1997 and 2011 were reviewed. There were 13 patients with a median gestational age of 39weeks. Location of the atresia was ascending colon (n=1), hepatic flexure (n=9), proximal transverse colon (n=2) and sigmoid colon (n=1). The primary procedure was: primary anastomosis (n=1), right hemicolectomy followed by ileo-colic anastomosis (n=2), right hemicolectomy and stoma formation (n=3). Six patients underwent stoma formation, of which five subsequently had a right hemicolectomy at a later procedure. In total, 10/12 patients required right hemicolectomy to facilitate restoration of bowel continuity. Median time to full feeds was 11days (4-46). Median follow up time was 11months (22days-5.6years). A temporising stoma does not reduce the discrepancy in the calibre of the atretic ends in proximal colonic atresia. Right hemicolectomy and ileo-colic anastomosis should therefore be considered at the initial surgery.