Abstract
Objective This report documents the authors' experiences in the management of “complex” jejunoileal atresia (JIA) and provides a review of the recent literature on “simple” and “complex” JIA. Materials and Methods This is a retrospective study of eight cases of “complex” JIA managed at the Pediatric Surgical Unit of Infermi Hospital in Rimini from 2002 to 2012. The inclusion criteria are all cases of JIA associated with distal bowel deformities and Types IIIb or IV. One patient had gastroschisis. Results The authors of this study performed primary anastomosis on three patients and enterostomies on five patients. In one case in which a patient presented with gastroschisis, the V.A.C. Therapy System (KCI Medical Ltd., Langford Locks, Kidlington, UK) was used to close the abdominal defect. All patients needed central venous catheter (CVC). Total parenteral nutrition (TPN) was administered for a mean of 12 days. Oral feeding was introduced on mean day 7 (7.71 ± 3.40 standard deviation). Patients with enterostomy began extracorporeal stool transport on mean day 14. No outcomes resulted in short bowel syndrome (SBS). The mortality rate was zero. The authors of this study performed more enterostomies and CVC insertion than other authors in “complex” JIA and reported a percentage of SBS, complications of TPN, and start of oral feeding comparable to “simple” case reported by other authors. Conclusions The results demonstrate that the complexity of JIA alone is not associated to a worsening prognosis than simple atresia if the surgical and clinical approach is as conservative as possible.
Highlights
The jejunoileal atresia (JIA) is a rare congenital malformation, which occurs in 1 of 5,000 newborns.[1]
We are reporting our experience in the management of complex cases of JIA and reviewing the results described in literature
We used the same criteria of inclusion reported by Lee et al for “complex” JA10: all cases of JIA associated to distal bowel deformities and Type IIIb (►Fig. 1) or IV (►Fig. 2), according to the classification of Grosfeld et al[2] (►Table 1)
Summary
The jejunoileal atresia (JIA) is a rare congenital malformation, which occurs in 1 of 5,000 newborns.[1]. Blanc[3] as an occlusion of the proximal jejunum associated to an absence of gross parts of the mesentery and variable large parts of the small intestine with a characteristic helical appearance of the preserved terminal ileum. Many studies confirmed[4,5,6,7] that the mortality in case of intestinal atresia have decreased steadily throughout the 20th century from 906 to 16%.5,8,9. Thanks to the improvements in neonatal anesthetic and surgical techniques and the use of total parenteral nutrition (TPN).[5] There is a recent literature focusing on complex cases of jejunal atresia (JA) that are associated with a much higher morbidity and mortality than received September 10, 2013 accepted after revision December 29, 2013 published online July 17, 2014
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