Pattern and Outcome of Small Bowel Atresia in Khartoum Teaching Hospital

Abstract

ABSTRACT Introduction: Small bowelatresia is a common cause of neonatal intestinal obstruction. Duodenal atresia occurs most properly due to failure of recanalization of the foregut during the 8-10 weeks of gestation, while jejuno-ilealatresia is due to intra uterine ischemic insult.Jejuno-ilealatresia is the commonest type of bowel aresia ,. Objectives: To describe the site ,clinical presentation, surgical treatment and outcome of bowel atresia. Patients & Method: This study wasprospective , descriptive , analytic, hospital based study. Result: Study of 40 patients with small bowel atresia showed that; more than 80% of patients were neonates, males: females’ ratio was 1.4:1. Duodenal atresia was found in 27.5 % while jejunoilealatresia was found in 82.5% (57.5% was jejunal and 15% was ileal). All patients presented with vomiting most of them were bilious. Features of Down syndrome reported in four patients, all of them were duodenal (36%), cardiac anomalies occurred in 18% of duodenal atresia.No reported genitor-urinary anomalies because all the neonates presented late and not investigated for this anomalies . No associated ano-rectal malformations in our series .Malrotation was found in three patients one was duodenal and two were jejunoileal.Prematurity occurred in 20% of patients, low birth weight was found in 45%. Duodenal atresia was treated by duodenoduodenostomy, duodeno- jejunostomy or duodenotomy for stenosis. While jejunoilealatresia was treated resection and anastomosis in most of the cases, enteroplasty was done in patients with short bowel, one patient treated by stoma because of perforation and peritonitis. Mortality rate was 32.5% due to multiple causes; cardiac anomalies, jaundice, prematurity and type of atresia were the commonest causes. Conclusion: In our country lack of neonatal intensive care unit and total parenteral nutrition increases the mortality rate, availability of these things plus pre natal diagnosis will improve the outcome.