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= Abstract =

Intestinal Atresia - A Survey by the Korean Association of Pediatric Surgeons -

IK Kim, M.D., SY Kim, M.D., SK Kim, M.D., WK Kim, M.D., JE Kim, M.D.,

JC Kim, M.D., HH Kim, M.D., KW Park, M.D., YS Park, M.D., WH Park, M.D.,

YT Song, M.D., JW Yang, M.D., SM Oh, M.D., SY Yoo, M.D., OS Lee, M.D.,

MD Lee, M.D., SK Lee, M.D., SC Lee, M.D., SI Chang, M.D., SY Chung, M.D.,

SE Chung, M.D., ES Chung, M.D., PM Jung, M.D., MH Cho, M.D., KJ Choi, M.D.,

SO Choi, M.D., SH Choi, M.D., YS Huh, M.D., C Hong, M.D., EH Whang, M.D.

The Korean A ssociation 0/ Pediatn'c SU1'geons

A survey on the intestinal atresias was made among 34 members of Korean Association of Pediatric Surgeons. The response rate was 82.4 %. Two hundred and fifteen patients from the January 1, 1994 to December 31, 1996 were analyzed. The lesions were 73 cases of duodenum(DA), 72 cases of jejunum(JA), 71 cases ileum(IA) and 2 cases cecum and sigmoid colon respectively. There were 2 cases of combined anomalies (DA + JA + IA and DA + JA). Male to female ratio was 1:1 in DA, and 1.8:1 in JA. Seventy· four cases(34.3 %) were premature babies(DA 35.2 %, JA:48.6 %,

IA:19.2 %), and 62 cases(28.7 %) had low birth weight (DA:39.4 %, JA 33.0 %, IA:13.7 %) . Antenatal diagnosis was made in 92 cases(43.6 %) . However 22 cases (23.9 %) of them were transferred to pediatric surgeon after delivery. Maternal polyhydramnios was observed in 63 cases(28.9 %). Seventy· five cases(34.4 %) were taken only simple

abdominal film for diagnostic studies. The associated malformations were observed in

Correspondence .: In Koo Kim. M.D., Pediatric Surgery,

Department 0/ Surgery, Asall Medical Center, 388-1

Pun,P,nap-dollg, SOI1Rpa-Rlt, Seoul 138-736, Korea

i'!:- '=-*-f'.:- 1998';1 JlJ-'T <>1IA1 7H~Hl ;,ll tHI ql ~~o}~1

J!}~~I ~711 ~~tH §I "1lA1 'T-'11 ~21 ~ "J-1£.£1 '3i %

- 75 -

54 aresia and were observed more frequently in DA(35 cases, 47.9 %). Meconium peritonitis due to intrauterine bowel perforation was more frequently associated with IA compared to DA and JA. The overall mortality rate was 30 %. (Abbreuations: PT;p-value in total, PDJ,DI,JI;P . value between two groups among duodenal, jejunal and ileal groups)

Index Words: Intestinal atresia, Duodenal atresia, Tejunal atresia, Ileal atresia

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- 76-

Table 1. Number of Registered Cases

DA

Male 37 Female 36

Total 7 3

, Two cases of ileocolic and sigmoid atresia I Two cases of DA +JA + IA and DA +JA PT<0.05. PDI<0.05. POJ. PJI>0.05

Table 2. Gestational Age

JA IA Total

4] 52 130

31 21 88

72 73' 218 +

DA(n = 71) JA(n =72 ) TA(n = 73 ) Tota\(n = 216)

< 37wks 37~42wks

25(35.2) 46(64.8)

PT<O.OOI. P.J1<O.OOl. PO.I. POI>0.05

Table 3. Birth Weight

35(48.6) 37(5l.4)

14(19.2) 59(80.8)

74(34.3) 142(65.7)

DA(n = 71) JA(n = 72) IA(n = 73) Tota\(n = 216)

~2.5kg

2.6~4.5kg

28(39.4) 43(60.6)

24(33 .3 ) 48(66.7)

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Table 4. Place of Birth and Prenatal Diagnosis

Prenatal Dx.

(+) (- )

Total

P<O.OOI

Surgeon's hospt .

70 26

96

Table 5. Maternal Polyhydramnios

10(13.7) 63(86 .3 )

7) ~EH2j-~ ~-w

62(28.7) 154(71.3)

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Other hospt .

22 93

115

Total

92 119

211

DA(n = 73) JA(n=72) IA(n = 73) Tota\(n = 218)

Yes No

33(45.2) 40(54.8)

PT<O.OOI. P.II. POI < 0.005. PIJJ>0.05

23(3l.9) 49(68.1)

- 77 -

7(9.6) 66(90.4)

63(28.9) 155(7l.1)

Table 6. Symptomatology

Vomiting Bilous aspirate Abd . distension Jaundice Feeding intolerance Meconium passage(- ) Lethargy Aspiration

Table 7. Diagnostic Work- up

Simple abdomen only Simple abdomen + others

Table 8. Associated Anomalies

No .of Pts'(%)

CHD Trisomy 21 Trisomy 18 ARM EA Om- G CDH

DA(n = 73)

46 29 22 22 17 15 8 6

DA(n = 73)

30(41.1) 43(58.9)

DA(n = 73)

35 (47 .9)

14 15 o 3 3 o o

·PT < O.OOl. POJ. POl < O.OOl. P.Jl>0.05

JA(n = 72)

51 36 15 14 13 16 10 3

JA(n = 72)

22(30.6) 50(69.4)

JA(n = 72)

10(13.9)

3 0 1 0 0 0 0

IA(n=73)

23(31.5) 50(68.5)

IA(n=73)

9(12.3)

2 0 0 1 0 2 1

IA(n = 73)

52 35 62 14 21 27

9 1

Total(n = 218)

75(34.4) 143(65.6)

TotaJ(n = 218)

54(24.8)

19 15

1 4 3 2 1

Abbreviations: CHD ;congenital heart disease. ARM ;anorectal malformation. EA ;esophageal atresi . Om- G ;omphalocale and gastroschisis. CDH ;congenital diaphragmatic hernia

Table 9. Associated Intraabdominal Conditions

DA(n = 73)

Annular pancreas 16 Malrotation 23 SB volvulus 0 Intussusception 0 Meconium peritonitis 0

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- 78 -

Table 10. Types of Duodenal Atresia

Types

Atresia with continuity of bowel wall Atresia with fibrous cord Atresia with gap between blind ends Complete diaphragm Stenosis due to stricture Stenosis du e to diaphragm with a central hole Windsock web Unknown

Total

Table 11. Types of Jejunoileal Atresia

Types

Atresia with continuity of bowel wal](type I)

Atresia with fibrous cord(type II)

Atresia with gap between blind ends(type IlIa) Christmas tree deformity(type IIIb) Multiple atresia(type IV) Stenosis Unknown

Total

No. of Cases

19 7 9 3

16 6 2

11

73

No. of Cases

28 28 45 14 13 10 7

145

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Table 12. Time for Full Feeding without IV Supplementation

Duodenal atresia (n = 31)

Duodenal stenosis (n = 22)

Jejunoileal atresia

Type I1lb(n = 12)

Others (n = 102)

Upper jejunal atresia(n = 32)

Others(n = 87)

Upper jejunal atresia

plication or tapering(+)(n = 9)

plication or tapering(- ) (n = 23)

- 79 -

Time(days)

17.3±9.4 } 12.7 ± 4.0

26.5± 14.7 } 19.6 ± 21.6

26.3+19 .2 } 19.3 ± 22.3

28.2+ 18.0 } 25.5 ± 20.0

··8

······3 ...... .... ........... 1

.2

........ 1

P-value

< 0.05

> 0.05

< 0.05

> 0 .05

Table 13. Morbidity and Mortality

No" of Pts. Sepsis Leakage Self , discharge Resp. fa ilure Heart fail u re NEe Adhesive i leus a nastomotic ma lfunction Barium peri t onit is Others .

DA(n = 73)

20(10) 6(3) o 3(3) 2(2) 2(2)

o 3

o o 4

*Morbidity:PT< 0 .005. PD,!. P,II <0.05. PD!> 0.05

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26

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38(10) 4 (3) 8(4) 2(2) o o o

10 5 1(1)

11

IA (n = 73)

24 (10) 8 (5 ) 1(1) 1(1) 1(1) 0 3 (2) 1 0 0

11

( ) :Morbidi t y

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82 (30) 18 (11) 9(5) 6(6) 3 (3 ) 2(2) 3 (2)

14 (0) 5(0) 1(1)

26(0)

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- 80 -

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1. Donnellan WL, Schafer JC: High Jejunal

obstruction, in Donnellan WL(eds): Abdominal

Surgery of Infancy and Childhood, chapter 17.

Harwood Acadenic Publishers, Luxembourg,

1996, PpI7/l-17/7

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