Surgical treatment of neonatal intestinal malformations

Abstract

Oesophageal atresia (OA) is a congenital anomaly with an interruption of the oesophageal continuity with or without tracheo-oesophageal fistula (TOF). Type IIIB is the most common (85%) and shows hypersalivation post partum followed by recurrent attacks of suffocation as a consequence of recurrent aspirations. A nasogastric tube cannot be passed and radiodiagnostic investigations visualize the blind-ending upper oesophageal pouch. Surgical management includes the closure of the TOF and primary anastomoses of the blind ends. In case of a long gap, narrowing and delayed primary repair can be performed. Prognosis and survival are related to birthweight and to associated major cardiac defects. In patients with congenital duodenal atresia (DA), the complete interruption of the bowel continuity can be diagnosed antenatally by sonography and post partum by plain abdominal radiographs, showing the classic ‘double bubble’ sign. The obstruction can be due to an intraluminal web, complete separation of the duodenal ends, or caused by an extraluminal pancreas annulare or Ladd bands seen in the case of malrotation. Infants show bilious vomiting after birth and consecutive metabolic alkalosis. The surgical method to bypass the obstruction is a duodenoduodenostomy. Mortality rate is < 5%. Jejunoileal atresia (JIA) is a common cause of neonatal intestinal obstruction. More than 90% of patients have a single atresia. In the case of multiple atresias, most of the children are born prematurely with low birthweight. JIAs can be suspected prenatally via sonography. Main symptoms are bilious vomiting, a distended abdomen and signs of life-threatening sepsis in the case of bowel perforation. Surgical treatment has the aim of reconstructing bowel continuity and saving as much bowel length as possible to avoid the complications of short bowel syndrome and malabsorptive syndromes. Anorectal malformations (ARMs) comprise not only defects of the lowest part of the intestinal tract but also of the urinary and genital tract. In minor low types, the rectum and its fistula open into the perineal region and primary surgical repair by posterior sagittal approach is performed. In higher, more complex types, meconium passes into the male urethra or bladder or into the female vagina. In these cases, a colostomy and staged repair has to be performed. Complex types of ARM have a poorer outcome regarding bowel and urinary control.