B. Intestinal atresia or stenosis
This results from intrauterine vascular insult.
Location. Distal ileum > proximal jejunum > duodenum > colon.
Diagnosis
Antenatal ultrasound
Polyhydramnios.
Dilated intestinal loops.
Neonatal history and physical
Symptoms appear shortly after birth for atresia but may take weeks to months for stenosis.
Bilious vomiting.
Abdominal distention.
Failure to pass meconium.
Failure to thrive.
Poor feeding.
Radiology
A “double-bubble” sign is diagnostic of duodenal obstruction.
Contrast enema may be used to identify a distal intestinal atresia and can also identify obstruction secondary to meconium ileus or meconium plug syndrome.
Management
Nasogastric decompression.
Intravenous fluid.
Ampicillin (50 mg/kg) and gentamicin (2.5 mg/kg) should be given preoperatively.
Operative intervention
Primary anastomosis, which may require resection or tapering of the dilated proximal segment.
For duodenal atresia, a duodenoduodenostomy or duodenojejunostomy is created to bypass the obstruction.
Saline should be infused into the distal bowel to rule out synchronous intestinal atresias.