Atresia of the intestine

Atresia( infection, obliteration) of the intestine is a congenital pathology of the development of the child's gastrointestinal tract, consisting of a lack of lumen on one of its sections.

Depending on the location of the pathology, several types of atresia are distinguished:

• pyloric - located immediately after the stomach;
• atresia of the duodenum - located at the very beginning of the small intestine;
• jejunal atresia - the site is located between the upper and lower part of the small intestine;
• atrial ileum;
• atresia of the colon - is diagnosed in the area of ​​the rectum and anal opening.

Atresia of the duodenum

Atresia of the duodenum is formed on the second - third gestational month. For pathology, a typically complete closure of the lumen of the intestinal tube. In this case, there is a significant expansion of its proximal end, capable of reaching volumes of stomach size. In this case, distally located intestinal loops have a small diameter and are welded together.

On atresia of the duodenum, the following signs may indicate:

• regurgitation of amniotic fluid;
• after vomiting in the child develops vomiting with impurities of bile. This is explained by the fact that the intestinal infection is located below the feces papilla;
• abdomen with palpation painless and soft, visually - retracted;
• with obliteration of the duodenal ulcer, the departure of the original feces is observed, but then the stool is completely stopped;
• in the first day - two after birth the baby remains calm - the general condition of the child is normal. Later, he develops signs of toxicosis and exhaustion: the fat layer disappears, facial features sharpen, the skin becomes dry;
• develops aspiration pneumonia.

Diagnosis and treatment

To determine the preliminary diagnosis, the radiography technique is used. The image will clearly show gas bubbles located in the stomach and duodenum. The intestinal loops remain free. To obtain a more accurate image, a contrast technique is used.

The X-ray image clearly shows the absence of the area of ​​the duodenum

Additionally, differential diagnostics with other congenital anomalies, in particular, ring-shaped pancreas, is carried out. Treatment of pathology requires immediate surgical intervention. Its type depends on the location of atresia with respect to the feces papilla.

In case of GI tract infection, duodenojunoanastomosis is superimposed, if obliteration is located higher, then gastroenteroanastomosis is performed. After the operation, the child has a fairly long time, there may be signs of dysfunction of the duodenum - regurgitation and vomiting.

Small intestinal pathology

Atresia of the small intestine in newborns is diagnosed most often in the lower ileum. Somewhat less common in the upper gastrointestinal tract. In some cases, the presence of a membranous septum is the cause of the obstruction of the intestinal tube.

At a small intestine atresia, a rather characteristic clinical picture is formed in the newborn:

• , the child develops indomitable vomiting with impurities of bile blood, later there are admixtures of fecal matter;
• meconium is not observed;
• after feeding, the peristalsis of the intestine, which is clearly visible through the abdominal wall, is greatly enhanced;
• bloating occurs on the background of a decrease in secreted urine, up to the complete cessation of its retreat;
• vomiting causes the development of toxicosis and rapid weight loss, despite a good appetite.

Symptoms of small intestinal atresia appear in the first day of the baby's life.

The abrupt wall of the abdominal wall indicates an intestinal rupture. The condition of the newborn deteriorates sharply, the skin covers acquire a characteristic gray-green color.

The basic methodology of pathology diagnostics is X-ray study. If in addition to the characteristic gas bubble, several more bubbles with a level are different, then the location of atresia is the upper sections of the gastrointestinal tract.

Numerous air bubbles with fluid levels become a sign of atresia localized in the lower ileum or at the very beginning of the large intestine. In the course of roentgenology, the use of barium porridge by the oral route is strictly forbidden.

The disease has a poor prognosis, but in term infants with an early operation and a small number of atresias it improves. Operative intervention is recommended immediately after the detection of pathology.

Rectal atresia

Rectal atresia is a congenital pathology characterized by underdevelopment of the anus( anus).Most often, the anomaly is diagnosed in boys. The disease requires an urgent surgical correction, carried out within the first 24 hours after birth.

Pathology is formed in the early antenatal period( from 12 to 29 gestational week) and is caused by impaired fetal development. The condition is characterized by the absence of an opening on the proctodeum( a depression at the posterior end of the trunk of the embryo, which then becomes an anus), and also not by the separation of the cloaca.

Classification of

Rectum atresia divided into:

• for high( supravagant);
• average;
• is low( sub-pitched).

The second classification of the pathology divides rectal atresia into total( complete incision of the lumen of the intestinal tube occurs, without fistula), occurring only in 10% of all diagnosed cases, and the fistulous format, on which the remaining 90% come.

The fistulous form of rectal atresia is of the following types:

• the pathological canal is excreted into the organs of the urinary system;
• fistula is released into the reproductive system;
• directly into the perineum.

Symptoms of

The first clinical signs of pathology are formed 12 hours after the birth of a child - he becomes restless, sleeps badly, refuses to take his chest and almost always tuzhitsya. By the end of the first day of life, symptoms of intestinal obstruction appear: the absence of meconium;the child starts to puchit - there is a strong bloating.

Vomiting is discovered, which includes bile and feces, signs of intoxication and dehydration. If the infant does not receive qualified medical care in the near future, it will die from perforation of the intestine and subsequent peritonitis.

With a low atresia of the rectum, instead of an anus, the child has a small funnel-shaped depression. Sometimes it is completely absent.

In some cases, the anomaly manifests as a gut infection and then the anus is simply blocked by a film through which the accumulated meconium is clearly visible. Sign of this form of pathology is the bulging of the anus during stress, the so-called "push" syndrome. With high, supralevant atresia, it is absent.

After birth, all children without exception are tested for congenital anomalies. The anal area is subjected to compulsory examination. In the case of pathology, instead of the anus, the child will have a slight depression.

It is important for medics to determine the severity of the pathology. If the infant lacks only the anus, and the colon itself is fully developed, then during the crying in the child in the region of the anus, a protrusion is observed.

Fistulas that enter the urinary system are diagnosed in most cases in male infants. In girls, this type of atresia is much less common. A sign of pathology is the presence in the urine of meconium particles, and when straining from the urethra, gases emerge.

Sign of the fistula of the large intestine, which has an outlet into the vagina, becomes the allocation of the original feces through the genital cleft. Acute intestinal obstruction with this format of atresia does not develop, but the release of feces in a similar manner leads to the formation of vulvitis and various inflammations of the urinary system.

Another option for opening a fistula is the perineal region. Most often, the abnormal canal forms near the anus, the scrotum or the base of the penis. Performing a normal act of defecation is also impossible, so the baby has symptoms of intestinal obstruction in the next few hours.

Diagnosis and treatment of

For the diagnosis of atresia, an X-ray study is assigned to the infant. In some cases it is enough to palpate the rectum, during which the doctor encounters an obstacle.

Treatment of rectal atresia is possible exclusively surgically. Babies with sublethal( low) atresia of the rectum perform perineal plastic. With medium and high pathology, the terminal colostomy is formed in the course of the surgical intervention( withdrawal of a part of the colon or sigmoid colon to the left side of the abdomen) with subsequent correction.

Infantile-treated infant with

-derived colostomy After surgical treatment of moderate and high atresia, fecal incontinence often develops in children. The prognosis in the absence of adequate therapy is unfavorable: the child's death comes on the fifth - the sixth day after birth. But also in time carried out operation is not a guarantee of full recovery. The intestine is fully functional only in 30% of the operated babies.

Colon atresia

Colon atresia is characterized by complete obstruction of this part of the intestine. There is a very rare pathology and is only 2% of all diagnosed cases of intestinal atresia. The cause of the formation of an anomaly is the intrauterine necrosis of the large intestine as a result of pathological conditions, in particular, a bloat.

Symptoms of atresia of the colon are formed in the infant for the second - third day. It is indomitable vomiting, containing meconium admixtures, bloating. At visual inspection it is possible to notice the stretched loops of an intestine, appearing through an abdominal wall.

Diagnostics includes mandatory radiography. The image clearly shows numerous gas bubbles with horizontal liquid levels. The loops of the intestine are stretched, and the non-functioning segment of the intestine looks like a thin cord.

Atrezirovanny area can be diagnosed in any part of the colon

Treatment of pathology surgical and is to remove the atrezirovannogo intestinal tract followed by imposing a large intestine anastoma. In the case of rupture of the gut and the development of peritonitis, a proximal colostomy can be installed.

Intestinal atresia is one of the most complex anomalies in the formation of the intestinal tract. After diagnosing the pathology, the infant needs an emergency surgical intervention. Otherwise, the disease has an extremely unfavorable prognosis.