DOCSLIB.ORG

Intestinal Atresia and Stenosis a 25-Year Experience with 277 Cases

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Intestinal Atresia and Stenosis a 25-Year Experience with 277 Cases PAPER Intestinal Atresia and Stenosis A 25-Year Experience With 277 Cases Laura K. Dalla Vecchia, MD; Jay L. Grosfeld, MD; Karen W. West, MD; Frederick J. Rescorla, MD; L. R. Scherer, MD; Scott A. Engum, MD Objective: To evaluate the causes, clinical presenta- excision in 5 (4%), and the Bianchi procedure in tion, diagnosis, operative management, postoperative care, 1(0.8%). Patients with colon atresia were managed and outcome in infants with intestinal atresia. with initial ostomy and delayed anastomosis in 18 (86%) of 21 patients and resection with primary anas- Design: Retrospective case series. tomosis in 3 (14%). Short-bowel syndrome was noted in 32 neonates. Setting: Pediatric tertiary care teaching hospital. Main Outcome Measures: Morbidity and early and Patients: A population-based sample of 277 neonates late mortality. with intestinal atresia and stenosis treated from July 1, 1972, through April 30, 1997. The level of obstruction Results: Operative mortality for neonates with duode- was duodenal in 138 infants, jejunoileal in 128, nal atresia was 4%, with jejunoileal atresia, 0.8%, and with and colonic in 21. Of the 277 neonates, 10 had obstruc- colonic atresia, 0%. The long-term survival rate for chil- tion in more than 1 site. Duodenal atresia was as- dren with duodenal atresia was 86%; with jejunoileal atre- sociated with prematurity (46%), maternal poly- sia, 84%; and with colon atresia, 100%. The Bianchi pro- hydramnios (33%), Down syndrome (24%), annular cedure (1 patient, 0.8%) and growth hormone, glutamine, pancreas (33%), and malrotation (28%). Jejunoileal atre- and modified diet (4 patients, 1%) reduced total paren- sia was associated with intrauterine volvulus, (27%), gas- teral nutrition dependence. troschisis (16%), and meconium ileus (11.7%). Conclusions: Cardiac anomalies (with duodenal atre- Interventions: Patients with duodenal obstruction sia) and ultrashort-bowel syndrome (,40 cm) requir- were treated by duodenoduodenostomy in 119 (86%), ing long-term total parenteral nutrition, which can be of 138 patients duodenotomy with web excision in 9 complicated by liver disease (with jejunoileal atresia), are (7%), and duodenojejunostomy in 7 (5%) A duode- the major causes of morbidity and mortality in these pa- nostomy tube was placed in 3 critically ill neonates. tients. Use of growth factors to enhance adaptation and Patients with jejunoileal atresia were treated with advances in small bowel transplantation may improve resection in 97 (76%) of 128 patients (anastomosis, 45 long-term outcomes. [46%]; tapering enteroplasty, 23 [24%]; or temporary ostomy, 29 [30%]), ostomy alone in 25 (20%), web Arch Surg. 1998;133:490-497 NTESTINAL ATRESIA is a well- RESULTS recognized cause of bowel ob- struction in the newborn. The DUODENAL ATRESIA management of neonates with in- AND STENOSIS testinal atresia has improved in Irecent decades due to refinements in Duodenal obstruction was found in 138 neonatal intensive care, operative tech- (50%) of the 277 neonates enrolled in the nique, use of total parenteral nutrition study, including 79 females (57%) and 59 (TPN), and neonatal anesthesia. This males (43%). Prematurity, defined as a ges- review evaluates the causes, clinical pre- tational age of 37 weeks or less, was noted From the Department of sentation, diagnosis, operative manage- in 64 neonates (46%). Maternal polyhy- Pediatric Surgery, James ment, postoperative care, and outcomes dramnios was noted in 45 neonates (33%) Whitcomb Riley Hospital for of 277 patients with intestinal atresia and evidence of duodenal obstruction on Children, Indiana University treated at a pediatric tertiary facility for a prenatal ultrasonograms was observed in Medical Center, Indianapolis. 25-year period. 22 (16%). In addition, the conditions of ARCH SURG/ VOL 133, MAY 1998 490 ©1998 American Medical Association. All rights reserved. Downloaded From: http://archsurg.jamanetwork.com/ on 08/20/2012 Type III Atresia (12%) Type II Atresia (12%) Type I Atresia (43%) Stenosis (33%) Figure 2. Pathological types of duodenal atresia and stenosis noted in the current series. Table 2. Associated Operative Findings With Duodenal Atresia and Stenosis Figure 1. Abdominal radiograph demonstrating the characteristic Pathologic Type No. (%) of Cases “double-bubble” sign associated with duodenal atresia. Annular pancreas 46 (33) Malrotation 39 (28) Anterior portal vein 7 (5) Table 1. Congenital Anomalies Associated Jejunoileal atresia 5 (3.6) With Duodenal Atresia Second distal web 2 (1.5) Colonic atresia 2 (1.5) Type No. (%) of Cases Ectopic pancreatic rests 2 (1.5) Meckel diverticulum 2 (1.5) Cardiac 53 (38) Jejunal duplication cysts 1 (,1) Renal 19 (14) Esophageal atresia or tracheoesophageal fistula 8 (6) Imperforate anus 7 (5) Skeletal 8 (6) Central nervous system 4 (3) distal duodenal atresia. Duodenoduodenostomy was per- Other* 11 (8) formed in 119 neonates (86%), duodenotomy with web excision in 9 (7%), and duodenojejunostomy in 7 (5%). *Other indicates additional anomalies. Three neonates underwent placement of a duodenos- tomy tube because of their critical condition. Addi- tional intraoperative findings included malrotation, an- 1 patient with omphalocele and 2 patients with gastros- nular pancreas, and anterior portal vein (Table 2). Ladd chisis had been diagnosed prenatally by ultrasonogram. procedure with appendectomy was performed in pa- Down syndrome (trisomy 21) was present in 33 neo- tients with evidence of malrotation. A concomitant gas- nates (24%). Clinical presentation included bilious eme- trostomy tube was placed in 50 neonates, most in the first sis or aspirates in 126 neonates, upper abdominal dis- 10 years of this series. In patients with esophageal atre- tension in 13, and feeding intolerance in 13. Diagnosis sia, the duodenal repair was performed prior to treating was achieved in most instances by plain abdominal ra- the esophageal atresia. Neonates with high imperforate diographs, which demonstrated the characteristic “double- anus also had a colostomy performed at the time of their bubble” sign in 108 neonates (Figure 1). No gas was duodenal atresia repair. observed beyond the second bubble in instances of atre- Postoperative complications included anastomotic sia. Upper gastrointestinal contrast-enhanced examina- obstruction in 4 neonates (3%), congestive heart failure tion showed partial duodenal obstruction in 48 neo- in 13 (9%), prolonged adynamic ileus in 6 (4%), pneu- nates with duodenal stenosis. A variety of associated monia in 7 (5%), and superficial wound infection in 4 congenital anomalies was noted, with cardiac or renal ab- (3%). Late complications included adhesive bowel ob- normalities most frequently documented (Table 1). struction in 13 children (9%), late duodenal dysmotility Surgery was performed after administration of in- resulting in megaduodenum that required tapering duo- travenous fluids to correct hypovolemia and electrolyte denoplasty in 5 (4%), and gastroesophageal reflux dis- abnormalities. Findings at the time of operation in- ease unresponsive to medical management that re- cluded atresia in 92 neonates (67%) (mucosal web [type quired antireflux surgery (Nissen fundoplication) in 7 I] in 59 [64%], fibrous cord [type II] in 16 [17%], or com- (5%). A late-appearing choledochal cyst that required ex- plete separation [type III] in 17 [18%]) and stenosis in cision and Roux-en-Y hepaticoenterostomy occurred in 46 (33%) (Figure 2). Two patients had a second, more 2 teenagers (1%). ARCH SURG/ VOL 133, MAY 1998 491 ©1998 American Medical Association. All rights reserved. Downloaded From: http://archsurg.jamanetwork.com/ on 08/20/2012 graphs usually showed an unused microcolon, a finding that reveals the obstruction is limited to the small intes- tine. The barium enema also documented the location of the cecum, alerting us to instances of associated dis- orders of intestinal rotation and fixation. Free air was ob- served on plain abdominal radiographs in 2 neonates I II (1.6%). Associated congenital anomalies included om- phalocele in 2 neonates (1.6%), cardiac anomalies in 10 (8%), skeletal anomalies in 3 (2%), gastroschisis in 21 (16%), renal abnormalities in 5 (4%), concurrent duo- denal atresia in 5 (4%), associated colonic atresia in 3 (2%), and central nervous system malformations in 4 (3%). At the time of surgery, 29 (23%) of the jejunoileal IIIa IIIb atresias were classified as type I (mucosal), 35 (27%) as type II (atretic fibrous cord), 23 (18%) as type IIIa (V- shaped mesenteric defect), 9 (7%) as type IIIb (“apple peel” atresia), and 31 (24%) as type IV (multiple atre- sias) (Figure 3). Other intraoperative findings in- cluded volvulus in 34 neonates (27%), malrotation in 24 (19%), meconium peritonitis in 10 (8%), Meckel diver- ticulum in 3 (2%), and intrauterine intussusception in 2 IV (1.6%). Additional atresias were noted in the colon in 3 Figure 3. Classification of jejunoileal atresia describes the pathology as patients and in the duodenum in 5 (4%). Operative man- type I (mucosal web), type II (fibrous cord), type IIIa (mesenteric gap agement included resection of the atresia with primary defect), type IIIb (“apple peel”), or type IV (multiple atresias). Reprinted from Pediatric Surgery1(p843) with permission from Mosby-Year Book Inc, formerly bowel anastomosis in 45 neonates (35%), resection with Year Book. tapering enteroplasty in 23 (18%), temporary ostomy in 54 (42%) (with intestinal resection in 29 [57%] of those), enterotomy with web excision in 5 (4%), and a Bianchi
Load more

Recommended publications
  • Megaesophagus in Congenital Diaphragmatic Hernia
    Megaesophagus in congenital diaphragmatic hernia M. Prakash, Z. Ninan1, V. Avirat1, N. Madhavan1, J. S. Mohammed1 Neonatal Intensive Care Unit, and 1Department of Paediatric Surgery, Royal Hospital, Muscat, Oman For correspondence: Dr. P. Manikoth, Neonatal Intensive Care Unit, Royal Hospital, Muscat, Oman. E-mail: [email protected] ABSTRACT A newborn with megaesophagus associated with a left sided congenital diaphragmatic hernia is reported. This is an under recognized condition associated with herniation of the stomach into the chest and results in chronic morbidity with impairment of growth due to severe gastro esophageal reflux and feed intolerance. The infant was treated successfully by repair of the diaphragmatic hernia and subsequently Case Report Case Report Case Report Case Report Case Report by fundoplication. The megaesophagus associated with diaphragmatic hernia may not require surgical correction in the absence of severe symptoms. Key words: Congenital diaphragmatic hernia, megaesophagus How to cite this article: Prakash M, Ninan Z, Avirat V, Madhavan N, Mohammed JS. Megaesophagus in congenital diaphragmatic hernia. Indian J Surg 2005;67:327-9. Congenital diaphragmatic hernia (CDH) com- neonate immediately intubated and ventilated. His monly occurs through the posterolateral de- vital signs improved dramatically with positive pres- fect of Bochdalek and left sided hernias are sure ventilation and he received antibiotics, sedation, more common than right. The incidence and muscle paralysis and inotropes to stabilize his gener- variety of associated malformations are high- al condition. A plain radiograph of the chest and ab- ly variable and may be related to the side of domen revealed a left sided diaphragmatic hernia herniation. The association of CDH with meg- with the stomach and intestines located in the left aesophagus has been described earlier and hemithorax (Figure 1).
    [Show full text]
  • Pediatric Gastroesophageal Reflux Clinical Practice
    SOCIETY PAPER Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ÃRachel Rosen, yYvan Vandenplas, zMaartje Singendonk, §Michael Cabana, jjCarlo DiLorenzo, ôFrederic Gottrand, #Sandeep Gupta, ÃÃMiranda Langendam, yyAnnamaria Staiano, zzNikhil Thapar, §§Neelesh Tipnis, and zMerit Tabbers ABSTRACT This document serves as an update of the North American Society for Pediatric INTRODUCTION Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European n 2009, the joint committee of the North American Society for Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Pediatric Gastroenterology, Hepatology, and Nutrition (NASP- 2009 clinical guidelines for the diagnosis and management of gastroesophageal GHAN)I and the European Society for Pediatric Gastroenterology, refluxdisease(GERD)ininfantsandchildrenandisintendedtobeappliedin Hepatology, and Nutrition (ESPGHAN) published a medical posi- daily practice and as a basis for clinical trials. Eight clinical questions addressing tion paper on gastroesophageal reflux (GER) and GER disease diagnostic, therapeutic and prognostic topics were formulated. A systematic (GERD) in infants and children (search until 2008), using the 2001 literature search was performed from October 1, 2008 (if the question was NASPGHAN guidelines as an outline (1). Recommendations were addressed
    [Show full text]
  • Abdominal Wall Defects—Current Treatments
    children Review Abdominal Wall Defects—Current Treatments Isabella N. Bielicki 1, Stig Somme 2, Giovanni Frongia 3, Stefan G. Holland-Cunz 1 and Raphael N. Vuille-dit-Bille 1,* 1 Department of Pediatric Surgery, University Children’s Hospital of Basel (UKBB), 4056 Basel, Switzerland; [email protected] (I.N.B.); [email protected] (S.G.H.-C.) 2 Department of Pediatric Surgery, University Children’s Hospital of Colorado, Aurora, CO 80045, USA; [email protected] 3 Section of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, 69120 Heidelberg, Germany; [email protected] * Correspondence: [email protected]; Tel.: +41-61-704-27-98 Abstract: Gastroschisis and omphalocele reflect the two most common abdominal wall defects in newborns. First postnatal care consists of defect coverage, avoidance of fluid and heat loss, fluid administration and gastric decompression. Definitive treatment is achieved by defect reduction and abdominal wall closure. Different techniques and timings are used depending on type and size of defect, the abdominal domain and comorbidities of the child. The present review aims to provide an overview of current treatments. Keywords: abdominal wall defect; gastroschisis; omphalocele; treatment 1. Gastroschisis Citation: Bielicki, I.N.; Somme, S.; 1.1. Introduction Frongia, G.; Holland-Cunz, S.G.; Gastroschisis is one of the most common congenital abdominal wall defects in new- Vuille-dit-Bille, R.N. Abdominal Wall borns. Children born with gastroschisis have a full-thickness paraumbilical abdominal Defects—Current Treatments. wall defect, which is associated with evisceration of bowel and sometimes other organs Children 2021, 8, 170.
    [Show full text]
  • Guideline for the Evaluation of Cholestatic Jaundice
    CLINICAL GUIDELINES Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ÃRima Fawaz, yUlrich Baumann, zUdeme Ekong, §Bjo¨rn Fischler, jjNedim Hadzic, ôCara L. Mack, #Vale´rie A. McLin, ÃÃJean P. Molleston, yyEzequiel Neimark, zzVicky L. Ng, and §§Saul J. Karpen ABSTRACT Cholestatic jaundice in infancy affects approximately 1 in every 2500 term PREAMBLE infants and is infrequently recognized by primary providers in the setting of holestatic jaundice in infancy is an uncommon but poten- physiologic jaundice. Cholestatic jaundice is always pathologic and indicates tially serious problem that indicates hepatobiliary dysfunc- hepatobiliary dysfunction. Early detection by the primary care physician and tion.C Early detection of cholestatic jaundice by the primary care timely referrals to the pediatric gastroenterologist/hepatologist are important physician and timely, accurate diagnosis by the pediatric gastro- contributors to optimal treatment and prognosis. The most common causes of enterologist are important for successful treatment and an optimal cholestatic jaundice in the first months of life are biliary atresia (25%–40%) prognosis. The Cholestasis Guideline Committee consisted of 11 followed by an expanding list of monogenic disorders (25%), along with many members of 2 professional societies: the North American Society unknown or multifactorial (eg, parenteral nutrition-related) causes, each of for Gastroenterology, Hepatology and Nutrition, and the European which may have time-sensitive and distinct treatment plans. Thus, these Society for Gastroenterology, Hepatology and Nutrition. This guidelines can have an essential role for the evaluation of neonatal cholestasis committee has responded to a need in pediatrics and developed to optimize care.
    [Show full text]
  • Intestinal Malrotation: a Diagnosis to Consider in Acute Abdomen In
    Submitted on: 05/20/2018 Approved on: 08/07/2018 CASE REPORT Intestinal malrotation: a diagnosis to consider in acute abdomen in newborns Antônio Augusto de Andrade Cunha Filho1, Paula Aragão Coimbra2, Adriana Cartafina Perez-Bóscollo3, Robson Azevedo Dutra4, Katariny Parreira de Oliveira Alves5 Keywords: Abstract Intestinal obstruction, Intestinal malrotation is an anomaly of the midgut, resulting from an embryonic defect during the phases of herniation, Acute abdomen, rotation, and fixation. The objective is to report a case of complex diagnostics and approach. The diagnosis was made Gastrointestinal tract. surgically in a patient presenting with hemodynamic instability, abdominal distension, signs of intestinal obstruction, and pneumoperitoneum on abdominal X-ray, with suspected grade III necrotizing enterocolitis. During surgery, a volvulus resulting from poor intestinal rotation was found at a distance of 12 cm from the ileocecal valve. Hemodynamic instability and abdominal distension recurred, and another exploratory laparotomy was required to correct new intestinal perforations. Therefore, early diagnosis with surgical correction before a volvulus appears is essential. Abdominal Doppler ultrasonography has been promising for early diagnosis. 1 Academic in Medicine - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil 2 Resident in Pediatric Intensive Care - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil 3 Associate Professor - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil. 4 Adjunct Professor - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil 5 Academic in Medicine - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil Correspondence to: Antônio Augusto de Andrade Cunha Filho. Universidade Federal do Triângulo Mineiro, Acadêmico de Medicina - Uberaba - Minas Gerais - Brasil.
    [Show full text]
  • Statistical Analysis Plan
    Cover Page for Statistical Analysis Plan Sponsor name: Novo Nordisk A/S NCT number NCT03061214 Sponsor trial ID: NN9535-4114 Official title of study: SUSTAINTM CHINA - Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Document date: 22 August 2019 Semaglutide s.c (Ozempic®) Date: 22 August 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL Clinical Trial Report Status: Final Appendix 16.1.9 16.1.9 Documentation of statistical methods List of contents Statistical analysis plan...................................................................................................................... /LQN Statistical documentation................................................................................................................... /LQN Redacted VWDWLVWLFDODQDO\VLVSODQ Includes redaction of personal identifiable information only. Statistical Analysis Plan Date: 28 May 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL UTN:U1111-1149-0432 Status: Final EudraCT No.:NA Page: 1 of 30 Statistical Analysis Plan Trial ID: NN9535-4114 Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Author Biostatistics Semaglutide s.c. This confidential document is the property of Novo Nordisk. No unpublished information contained herein may be disclosed without prior written approval from Novo Nordisk. Access to this document must be restricted to relevant parties.This
    [Show full text]
  • Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2017
    Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2017 Participating members of the Birth Defects Definitions Group: Lorenzo Botto (UT) John Carey (UT) Cynthia Cassell (CDC) Tiffany Colarusso (CDC) Janet Cragan (CDC) Marcia Feldkamp (UT) Jamie Frias (CDC) Angela Lin (MA) Cara Mai (CDC) Richard Olney (CDC) Carol Stanton (CO) Csaba Siffel (GA) Table of Contents LIST OF BIRTH DEFECTS ................................................................................................................................................. I DETAILED DESCRIPTIONS OF BIRTH DEFECTS ...................................................................................................... 1 FORMAT FOR BIRTH DEFECT DESCRIPTIONS ................................................................................................................................. 1 CENTRAL NERVOUS SYSTEM ....................................................................................................................................... 2 ANENCEPHALY ........................................................................................................................................................................ 2 ENCEPHALOCELE ..................................................................................................................................................................... 3 HOLOPROSENCEPHALY.............................................................................................................................................................
    [Show full text]
  • Duplication Cyst with Intestinal Volvulus Causing Intestinal Atresia/Stenosis in Neonates
    Journal of Neonatal Surgery 2018; 7:43 DOI: 10.21699/jns.v7i4.820. CASE SERIES Duplication Cyst with Intestinal Volvulus Causing Intestinal Atresia/Stenosis in Neonates Muhammad Bilal Mirza*, Imran Hashim, Shabbir Ahmad, Nabila Talat, M Zubair Shaukat, Muhammad Saleem Department of Pediatric Surgery, The Children’s Hospital and The Institute of Child Health, Lahore, Pakistan How to cite: Mirza B, Hashim I, Ahmad S, Talat N, Shaukat MZ, Saleem M. Duplication cyst with intestinal volvulus causing intestinal atresia/ stenosis in neonates. J Neonatal Surg. 2018; 7:43. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Duplication cysts of small bowel seldom present in newborns and usually represent the development of complications. In utero complications may lead to mesenteric vascular accidents and thus resulting in intestinal atresias. We report three neonates with duplication cyst of small bowel causing localized intestinal volvulus, leading to small bowel intestinal atresia/stenosis. The neonates underwent excision of the duplication cyst and resection anastomosis of the small bowel. Post-operative recovery was uneventful in all three of them. Key words: Atresia; Duplication cyst; Stenosis; Volvulus INTRODUCTION sound of abdomen showed dilated bowel loops. After adequate resuscitation, the patient was operated with Volvulus due to duplication cyst is a rare cause of suspicion of intestinal atresia. At surgery, a 3 cm × neonatal intestinal obstruction [1]. In utero volvulus 5 cm sized non-communicating cyst was encountered due to duplication cyst may also produce intestinal with 3–4 twists causing localized volvulus.
    [Show full text]
  • Congenital Pyloric Atresia: Clinical Features, Diagnosis, Associated Anomalies, Management and Outcome Osama A
    188 Original article Congenital pyloric atresia: clinical features, diagnosis, associated anomalies, management and outcome Osama A. Bawazira,b and Ahmed H. Al-Salemc Background Congenital pyloric atresia (CPA) is very rare period; however, 10 died later giving an overall survival of and usually seen as an isolated anomaly, which has an 40%. Sepsis was the main cause of death. excellent prognosis. CPA can be associated with other Conclusion CPA is a very rare malformation that can be anomalies or familial and these are usually associated with familial and inherited as an autosomal recessive. It can other hereditary conditions with poor prognosis. This either occur as an isolated lesion with an excellent review is based on our experience with 20 infants with CPA. prognosis, or be associated with other anomalies. Patients and methods This is a review of CPA, The overall prognosis of CPA, however, is still poor, and this highlighting its clinical features; associated anomalies; and is due to the frequent-and often fatal-associated aspects of diagnosis, management and outcome. anomalies. Ann Pediatr Surg 13:188–193 c 2017 Annals of Pediatric Surgery. Results This review is based on our experience with 20 patients with CPA (nine male and 11 female). Their mean Annals of Pediatric Surgery 2017, 13:188–193 birth weight was 2.1 kg (1.1-3.9 kg). Polyhydramnios was Keywords: aplasia cutis congenita, congenital pyloric atresia, seen in 13 (65%) patients. Seven patients were full-term epidermolysis bullosa, hereditary multiple intestinal atresia and the remaining 13 were premature. Two were brothers aDepartment of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, and four were members of the same family.
    [Show full text]
  • Nova Scotia Atlee Perinatal Database Coding Manual 15 Edition (Version
    Nova Scotia Atlee Perinatal Database Coding Manual 15th Edition (Version 15.0.0) April 2011 TABLE OF CONTENTS LISTINGS OF HOSPITALS 11 ADMISSION INFORMATION 16 DELIVERED ADMISSION 26 Routine Information – Delivered Admission 26 Routine Information – Labour 57 Routine Information – Infant 77 UNDELIVERED ADMISSION 94 Routine information – undelivered 94 POSTPARTUM ADMISSIONS 104 Routine Information – Postpartum Admission 104 NEONATAL ADMISSIONS 112 Routine Information – Neonatal Admissions 112 ADULT RCP CODES 124 INFANT RCP CODES 143 INDEX OF MATERNAL DISEASES AND PROCEDURES 179 INDEX OF NEONATAL DISEASES AND PROCEDURES 195 1 INDEX FOR ADMISSION INFORMATION Admission date .............................................................................................................................. 17 Admission time .............................................................................................................................. 17 Admission process status ............................................................................................................... 25 Admission type .............................................................................................................................. 17 A/S/D number ................................................................................................................................ 18 Birth date ....................................................................................................................................... 18 Care provider attending ................................................................................................................
    [Show full text]
  • The Gastrointestinal Tract Frank A
    91731_ch13 12/8/06 8:55 PM Page 549 13 The Gastrointestinal Tract Frank A. Mitros Emanuel Rubin THE ESOPHAGUS Bezoars Anatomy THE SMALL INTESTINE Congenital Disorders Anatomy Tracheoesophageal Fistula Congenital Disorders Rings and Webs Atresia and Stenosis Esophageal Diverticula Duplications (Enteric Cysts) Motor Disorders Meckel Diverticulum Achalasia Malrotation Scleroderma Meconium Ileus Hiatal Hernia Infections of the Small Intestine Esophagitis Bacterial Diarrhea Reflux Esophagitis Viral Gastroenteritis Barrett Esophagus Intestinal Tuberculosis Eosinophilic Esophagitis Intestinal Fungi Infective Esophagitis Parasites Chemical Esophagitis Vascular Diseases of the Small Intestine Esophagitis of Systemic Illness Acute Intestinal Ischemia Iatrogenic Cancer of Esophagitis Chronic Intestinal Ischemia Esophageal Varices Malabsorption Lacerations and Perforations Luminal-Phase Malabsorption Neoplasms of the Esophagus Intestinal-Phase Malabsorption Benign tumors Laboratory Evaluation Carcinoma Lactase Deficiency Adenocarcinoma Celiac Disease THE STOMACH Whipple Disease Anatomy AbetalipoproteinemiaHypogammaglobulinemia Congenital Disorders Congenital Lymphangiectasia Pyloric Stenosis Tropical Sprue Diaphragmatic Hernia Radiation Enteritis Rare Abnormalities Mechanical Obstruction Gastritis Neoplasms Acute Hemorrhagic Gastritis Benign Tumors Chronic Gastritis Malignant Tumors MénétrierDisease Pneumatosis Cystoides Intestinalis Peptic Ulcer Disease THE LARGE INTESTINE Benign Neoplasms Anatomy Stromal Tumors Congenital Disorders Epithelial Polyps
    [Show full text]
  • Duodenal Stenosis: a Diagnostic Challenge in a Neonate with Poor Weight Gain
    Open Access Case Report DOI: 10.7759/cureus.8559 Duodenal Stenosis: A Diagnostic Challenge in a Neonate With Poor Weight Gain Ma Khin Khin Win 1 , Carole Mensah 1 , Kunal Kaushik 1 , Louisdon Pierre 1 , Adebayo Adeyinka 1 1. Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA Corresponding author: Carole Mensah, [email protected] Abstract Cases of isolated duodenal stenosis in the neonatal period are minimally reported in pediatric literature. Causes of small bowel obstruction such as duodenal atresia or malrotation with midgut volvulus have been well documented and are often diagnosed due to their acute clinical presentation. Duodenal stenosis, however, causes an incomplete intestinal obstruction with a more indolent and varying clinical presentation thus making it a diagnostic challenge. We present a neonate with a unique case of congenital duodenal stenosis. The neonate presented with poor weight gain and frequent "spit-ups" as per the mother at the initial newborn visit. The clinical presentation was masked as the patient was being fed infrequently and with concentrated formula. We postulate that this may be due to the fact that the mother was an adolescent and relatively inexperienced with newborn care. During the hospital course, the patient had recurrent episodes of emesis with notable electrolyte abnormalities including hypochloremia and metabolic alkalosis. Further investigation with an abdominal X-ray showed dilated loops of bowel. Pyloric stenosis was ruled out via abdominal ultrasound. An upper gastrointestinal (GI) series ultimately confirmed a diagnosis of duodenal stenosis and the infant underwent surgical repair with full recovery. Congenital duodenal stenosis may have atypical presentations in neonates requiring pediatricians to have a high index of suspicion for diagnosis and to ensure timely therapy.
    [Show full text]