From the Guidelines
Intestinal atresias can be classified into five main types based on their anatomical appearance, which is crucial for surgical planning and management. These types include:
- Type I: a membrane or web that occludes the intestinal lumen while the bowel continuity remains intact
- Type II: a fibrous cord connecting two blind-ending intestinal segments
- Type IIIa: complete separation of blind-ending bowel segments with a V-shaped mesenteric defect
- Type IIIb: a large mesenteric defect with the distal bowel wrapping around a single perfusing vessel, also known as "apple peel" or "Christmas tree" atresia
- Type IV: multiple atresias giving a "string of sausages" appearance, as described in studies such as 1. The classification of intestinal atresias is important for determining the appropriate surgical approach, as each type requires specific operative techniques to ensure the best possible outcome in terms of morbidity, mortality, and quality of life 1.
In terms of imaging, intestinal atresias can be suspected based on radiographic findings, such as a double bubble or triple bubble sign with little or no gas distally, which indicates obstruction of the duodenum or jejunum, respectively 1. The etiology of intestinal atresia is believed to be related to intrauterine vascular accidents leading to ischemia and resorption of affected bowel segments, with the different types representing varying degrees of vascular compromise during fetal development.
It is essential to note that the diagnosis and management of intestinal atresias require a multidisciplinary approach, involving radiologists, surgeons, and other healthcare professionals, to ensure the best possible outcome for patients with this condition 1.
From the Research
Intestinal Atresias Types
There are several types of intestinal atresias, including:
- Duodenal atresia: a condition where there is a blockage in the duodenum, the first part of the small intestine 2, 3, 4, 5
- Jejunoileal atresia: a condition where there is a blockage in the jejunum or ileum, parts of the small intestine 2, 3, 4, 5
- Colonic atresia: a condition where there is a blockage in the colon, the large intestine 2, 3, 4, 5
- Multiple atresias: a condition where there are blockages in multiple parts of the intestine 5
Characteristics of Intestinal Atresias
The characteristics of intestinal atresias vary depending on the type and location of the blockage:
- Duodenal atresia is often associated with prematurity, maternal polyhydramnios, Down syndrome, annular pancreas, and malrotation 2
- Jejunoileal atresia is often associated with intrauterine volvulus, gastroschisis, and meconium ileus 2
- Colonic atresia is often associated with gastroschisis and malrotation 6
Treatment and Outcomes
The treatment and outcomes of intestinal atresias vary depending on the type and location of the blockage:
- Duodenal atresia is often treated with duodenoduodenostomy, duodenotomy with web excision, or duodenojejunostomy 2, 5
- Jejunoileal atresia is often treated with resection, anastomosis, or tapering enteroplasty 2, 3, 4, 5
- Colonic atresia is often treated with initial ostomy and delayed anastomosis or resection with primary anastomosis 2
- The overall survival rate for infants with intestinal atresia is high, with low morbidity and mortality rates 3, 4, 5