understanding-congenital-intestinal-atresia-and-stenosis-a-guide-for-modern-family-doctors

Title: Understanding Congenital Intestinal Atresia and Stenosis: A Guide for Modern Family Doctors

Overview: Congenital intestinal atresia and stenosis are common congenital digestive tract anomalies in neonates, often leading to intestinal obstruction. This article provides a comprehensive overview of the diagnosis and treatment of these conditions, offering valuable insights for modern family doctors.

Diagnosis:

(1) Clinical Presentation: Congenital intestinal atresia and stenosis present as complete intestinal obstruction, regardless of the level of the blockage. High-level atresia is characterized by vomiting after the first feeding, which becomes more frequent and severe, with vomit containing water, milk, and bile. Intestinal atresia in the ileum and colon may present with vomiting 2-3 days after birth, with vomit containing bile and meconium. In high-level atresia, the upper abdomen may swell, showing a gastric shape, which may disappear after剧烈 vomiting. In low-level atresia, the entire abdomen may swell, with increased bowel sounds, and possibly visible bowel loops. Infants may not pass meconium or only pass a small amount of greenish mucus-like material. High-level atresia can quickly lead to dehydration, electrolyte imbalance, and acidosis. Late-stage low-level intestinal atresia may be accompanied by bowel perforation, causing peritonitis. The timing of vomiting and the degree of abdominal distension in intestinal stenosis vary with the severity of the stenosis, and it may present as chronic incomplete intestinal obstruction. Severe stenosis may exhibit symptoms similar to atresia.

(2) Examination: - Abdominal X-ray: High-level atresia may show several fluid levels in the upper abdomen, while low-level atresia may show multiple dilated loops and fluid levels. - Barium enema: May reveal a narrow colon. - Barium swallow: Can determine the site of stenosis. Diagnosis can be considered based on persistent vomiting, no meconium passage, and progressive abdominal distension. Diagnosis can be confirmed through abdominal X-ray, barium enema, or nasogastric barium contrast.

Treatment: Once diagnosed, intestinal atresia should be treated surgically after correcting water, electrolyte, and acid-base imbalances. Treatment options include: - Duodenal atresia: Duodenoduodenal or duodenojejunal anastomosis. - Ileal and jejunal atresia: Resection of both blind ends followed by end-to-end anastomosis. - Colonic atresia: Initial colostomy, followed by a second-stage anastomosis and closure. - Intestinal stenosis: Resection of the stenotic segment followed by end-to-end anastomosis. Postoperative care includes fasting and gastrointestinal decompression for 5-7 days, followed by a gradual increase in feedings. Short bowel syndrome may require parenteral nutrition.

Conclusion: Early diagnosis and prompt treatment are crucial for managing congenital intestinal atresia and stenosis. Family doctors should be aware of the typical clinical presentations and diagnostic methods to ensure appropriate care for neonates with these conditions.