Atresia And Stenosis Of Colon

Question 1

Associated anomalies

Answer 1

jejunoileal atresia, Hirschsprung’s disease, and genitourinary malformations.

Nonfixation of the colon.

• Anal atresia and imperforated anus.
• Omphalocele.
• Absence of a hand.

Question 2

Clinical features

Answer 2

abdominal distention and failure to pass meconium.

Colonic stenosis- In less severe cases, the child may have chronic problems like bloating with feeds, cramping, or poor weight gain. The abdomen may become distended with feeding, and stool production is scant, if present.

Anus is normal

Question 3

Stenosis of colon is more common than atresia True or false

Answer 3

True

Question 4

Risk factors for colonic atresia

Answer 4

Prenatal maternal use of vasoconstrictive medications, such as cocaine, amphetamines, nicotine, or decongestants,

Question 5

Classification of colonic atresia

Answer 5

3 types
Type1 atresia: The colon and mesentery remain intact, but the bowel lumen is obstructed by a complete membrane.

Type 2 atresia: The colon is discontinuous, connected by a fibrous cord.

• Type 3 atresia: The colon ends are completely separated, and the mesentery has a gap.
• Colonic stenosis: Characterized by intact bowel with incomplete occlusion.

distribution of colonic atresia by site:

Ascending colon (28 %) 
Hepatic flexure (3 %)
Transverse colon (23 %)
Splenic flexure (25 %) 
Descending and sigmoid (20 %)

Question 6

Diagnosis

Answer 6

Ultrasonography may reveal bowel loop distention or polyhydramnios.

• Plain abdominal radiograph: Reveals bowel obstruction( air fluid levels ) with or without a prominent dilated loop and absence of gas in the rectum.

• Contrast enema:
− This is useful to rule out the presence of other atresias.
− It reveals a microcolon with a rounded proximal end at the site of atresia.

It ends abruptly at the level of obstruction before refluxing in the small bowel

congenital colonic stenosis
X-ray also reveals an obstructive intestinal pattern that may mimic atresia.

Contrast enema reveals narrowing of the colon, with limited filling of the dilated proximal colon
(Thin film of contrast passing proximally and the dilated right side of the colon ( arrows)

Question 7

Treatment

Answer 7

Nasogastric decompression

Intravenous fluid resuscitation

Intravenous antibiotics

Surgery - primary resection and anastomosis or stoma diversion(diverting colostomy )

proximal bulbous tip is either resected or tapered and a primary anastomosis is performed.

Or
A diverting colostomy just proximal to the site of atresia is done, and reanastomosis to be done at a second operation.