Clinicopathological study of Jejunoileal atresia.

Balasundaram, M (2008) Clinicopathological study of Jejunoileal atresia. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Intestinal atresia is one of the most common surgical disease in neonates. Jejunoileal atresia occurs more frequently than duodenal or colonic atresia. It accounts 30% of all cases of neonatal intestinal obstruction. The incidence of jejunoileal atresia varies between 1/300 and 1/3000 live birth. Ravitch et al estimated the over all incidence of intestinal atresia at 1 per 2719 live birth. Boys and girls are equally affected. Down Syndrome is most uncommon in babies with jejunoileal atresia compared with duodenal atresia. The intestine proximal to obstruction is usually dilated and hypertrophied and has a cynosed appearance and may have patches of necrotic areas. The peristaltic movement in this segment is subnormal and ineffective. The distal bowel is unused and worm like, potentially normal in length and function. If the atresia has occured late in intrauterine life the bowel distal to atresia have a near normal calibre. At the level of atresia, the ganglion of the enteric nervous system are atrophic and hypocellular. These changes are most likely the result of ischemia. Intestinal dysmotility is an important problem in the post operative management of patients with jejunoileal atresia. The alterations of neural and muscular elements and the extent of histologic changes proximal and distal to atresia may contribute to the postoperative intestinal dysmotility in these cases, but the etiology of this disease is not yet to be understood4. The distended proximal bowel produces a significant technical problem for anastomosis and also predisposes to the intestinal dysmotility as it is deficient of muscular and neural elements. The operative techniques and medical treatments, including nutritional therapy, have led to an improvement in the outcome of patients with intestinal atresia, some problems related to the management of intestinal atresia still remain unresolved. The post operative intestinal dysmotility is frequently associated with dilatation of the proximal intestinal segment but its etiology is not yet fully understood. Hypoplasia of intramural nerves and pacemaker cells and abnormal musculature in the proximal segment of jejunoileal atresia were accepted as causative factors for intestinal dysmotility. AIM : The aim of this study is to investigate the possible etiological factors of Jejunoileal atresia by evaluating the resected specimen histopathologically, regarding the histological structure of intestinal muscular layer and myentric plexuses. MATERIALS AND METHODS : For this study, Patients with complaints of Abdominal distension, Bilious vomiting and not passed Meconium were chosen. Patients admitted to the Paediatric Surgical department at ICH & HC, Chennai, Tamil Nadu during the period January 2007 to April 2008 were included in the study. Totally 20 No. of patients were included for the study. This study is a prospective study. Control tissues of Jejunum and ileum were obtained from 2 patients who underwent small bowel resection for intussusception. Patients of age group less than one month and either sex were included Informed consent for the study were taken in each case. The nature of surgery is resection and end to back anastanosis. Specimen is taken 5 cm of the proximal dilated segment and 3 cm of the distal segment. Ethical Committee clearance was obtained from the ethical committee of ICH & HC, Chennai. CONCLUSION : In our studies the proximal segment of atretic intestine showed structural deficits. Ganglion cells were normal. Defect in the intestinal musculature were prominent but intestinal mucosa was intact. These abnormalities were seen both on the antimesentric side and on the mesentric side, which support vascular accident as a causative factor. When possible adequate resection rather than tapering enteroplasty should accompany the repair of intestinal atresia to eliminate the intestinal segment with structural defects. When this is not feasible sufficient tapering is preferred. Muscular defect also present at the proximal end of distal atretic bowel and it requires resection at the time of surgical correction of atresia. Adynamic intestinal segment owing to insufficient resection may lead to prolonged intestinal dysmotility in the post operative period, which may result in sepsis and death.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Jejunoileal atresia ; Clinicopathological study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:59
Last Modified: 28 Jul 2017 02:59

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