Small bowel atresia is a developmental disorder of the small bowel. In this case, the lumen of the jejunum or ileum is not continuous.
What is small bowel atresia?
Small bowel atresia is a disease of the small intestine (intestinum tenue) that is already congenital. The small intestine is composed of the ileum and the jejunum and is not continuous. The reason for small bowel atresia is the sac-like protrusion of a membrane into the intestine or a so-called true atresia, in which a portion of the intestine is missing. The incidence of small bowel atresia is estimated at 1.3:10,000. Medicine divides atresia of the small intestine into several types. In type I, there is a protrusion of the membrane. Type II is when there are blind ends whose connection is made by a connective tissue band. In the case of type IIIa, the blind ends do not have a connection. Type IIIb is also called Apple-Peel deformity. Physicians refer to type IV when multiple atresias exist in succession.
Causes
Atresia of the small intestine is most often caused intrauterine due to a so-called vascular incident. The reason is often a small blood clot, which causes a portion of the small intestine to stop receiving enough blood. In older children or adults, this would result in an intestinal infarction, which is classified as a medical emergency. In unborn children, however, this process takes an intrauterine course. This means that the mother of the child does not notice it at all. For this reason, it is not always easy to detect small bowel atresia before birth.
Symptoms, complaints and signs
Small bowel atresia usually becomes noticeable after birth. In this case, the affected children suffer from intestinal obstruction (ileus). At the beginning of the condition, the babies still give a healthy impression. However, because food cannot be passed within the intestine, the result is usually bilious vomiting. Due to the already congenital interruption of the intestinal continuity, the contents of the intestine accumulate. The amount of disruption determines how much the infant’s abdomen distends. Little or even no meconium (neonatal stool) settling occurs. Depending on how pronounced the defect of the intestine is, it leads to vomiting sooner or later. In some cases, the vomit takes on a stool-like consistency. If the diagnosis of small bowel atresia takes place too late, there is a risk of perforation (piercing) of the small bowel, which in turn results in severe inflammation in the abdomen.
Diagnosis and course
Atresia of the small intestine is a medical emergency and requires prompt medical evaluation and treatment. If small bowel atresia is suspected, an ultrasound examination may be performed before birth. This is the case if dilated intestinal loops can be constantly visualized. It is also possible that an above-average amount of amniotic fluid (hydramnion) is present, which is considered an indication of small bowel atresia. Following birth, feeding is difficult and affected babies suffer from bilious vomiting. The higher the stenosis (narrowing) is located, the earlier the onset of vomiting. In the case of a deep stenosis, the doctor can recognize the atresia by a bulging abdomen. If atresia of the small intestine is suspected after the child is born, an x-ray examination of the abdomen is performed. This may sometimes require contrast imaging. Rapid treatment is important for the course of small bowel atresia. This always takes the form of surgical intervention. If the therapy takes place at the right time, the prognosis is considered positive. It usually takes a few days after surgery for the activity of the intestine to return to normal.
Complications
Due to the atresia of the small intestine, in the worst case, the so-called intestinal obstruction can occur. This represents a very dangerous condition for the human body and must be avoided at all costs. Vomiting also often occurs, and it is not uncommon for the affected person to vomit bile. The patient’s abdomen also feels bloated and there is no longer any appetite. The intestinal rupture can cause serious inflammation and infection in the abdomen, which can lead to severe complications. Without treatment, small bowel atresia can thus even lead to death.In most cases, treatment is symptomatic. However, it is not possible in all cases to treat the consequences and symptoms of small bowel atresia. Not infrequently, the patient is then dependent on an artificial bowel outlet, which extremely reduces the quality of life. The operation itself usually takes place without complications. However, the small bowel atresia makes everyday life more difficult for the patient. Sports and physical activities can usually no longer be taken up either. Life expectancy is not affected if early treatment is performed. In most cases, children can recover quickly from the disease.
When should you see a doctor?
Small bowel atresia is a medical emergency and must be evaluated and treated immediately. The condition is usually diagnosed immediately after birth and treated on the spot. Occasionally, atresia of the small intestine may be detected before birth. The doctor in charge will inform the parents of the affected child about the developmental disorder and prepare for postnatal surgery. In contrast, mild small bowel atresia is often not detected until after the child leaves the hospital. In the event of complications such as vomiting or intestinal obstruction, the parents should seek the nearest clinic as soon as possible. In the event of intestinal rupture, an emergency physician should be alerted. If small bowel atresia is left untreated, it can lead to death. Therefore, medical advice should be sought at the first sign of small bowel atresia. After the surgical procedure in which the small intestine is corrected, further follow-up visits are indicated. The details of which measures are appropriate depend on the individual symptoms and should always be discussed with the physician in charge.
Treatment and therapy
For successful treatment of small bowel atresia, surgical intervention cannot be avoided. Because of the different forms of enlargement of the intestine, the physician must decide before surgery whether to immediately suture the two remaining ends of the intestine together after removal of the stricture or to first create an artificial anus. This may be necessary, for example, if the diameters between the intestinal segments show too great a difference. The artificial intestinal outlet is called a protective stroma and assumes a protective function. As a rule, about three to four months after the operation, it comes back to the patient. The first step of the operation is opening the abdominal cavity. Then the surgeon carefully inspects the intestine to detect any other abnormalities and treat them if necessary. In most cases, there is a pronounced dilatation of the upper part of the intestine. In contrast, the lower portion, which is still unused, is usually atrophied and has only a small intestinal lumen. To connect the two portions, an oblique anastomosis technique must be performed. In most surgeries, an open procedure is performed. This means that an abdominal incision takes place. Thus, minimally invasive treatment cannot be performed for atresia of the jejunum. Following the surgery, intensive medical monitoring of the baby is performed. Breast milk is recommended as a food supply, the amount of which is carefully increased. It may take some time for the intestinal tract to reach full functionality. However, in most cases, children recover quickly.
Outlook and prognosis
Without medical care, the baby has a poor prognosis. With small bowel atresia, surgical intervention is essential or intestinal obstruction will occur. This can lead to intestinal rupture and a life-threatening condition. A much better prognosis exists for newborns who undergo immediate treatment. An operation is performed to correct the congenital malformation. Doctors also create an artificial intestinal outlet to ensure the patient’s survival. The baby is monitored intensively for some time and all functions are controlled. After several months, natural functioning of the intestine gradually takes place. The healing process with this procedure is lengthy and often difficult for the relatives as well as the newborn to cope with. Nevertheless, there are ultimately good prospects for healing in this way. In many cases, a second operation is necessary and the artificial anus is removed.Once the bowel is fully functional, the patient is discharged from treatment. Control examinations are not normally necessary. If the scarring causes discomfort or pain later in the procedure, laser therapy is used to treat the condition again. This does not change the good prognosis for small bowel atresia. The patient can have a symptom-free bowel for life.
Prevention
It is not possible to prevent small bowel atresia. Thus, it is an already congenital malformation.
What you can do yourself
Small bowel atresia involves a rare malformation of the small bowel in newborns. All known forms of atresia have in common that the small intestine is either closed in one or more places or has no connection to the continuing intestinal segments. This means that the contents of the small intestine cannot be passed on. In principle, this is the immediately threatening condition of intestinal obstruction, which requires surgical treatment as quickly as possible. Adjustment of behavior in everyday life is not advisable due to the urgency of treatment of the newborn. The main effort for the parents should be to have the affected newborn examined and operated on by experienced specialist surgeons in an appropriate specialist clinic, otherwise the prognosis for the course of this rarely occurring disease will deteriorate visibly. Efficient self-help measures do not exist, because regardless of the manifestation of small intestinal atresia, the lack of intestinal transit can only be restored by surgical-mechanical means. If there are indications of small bowel atresia even before birth, the suspicion can be invalidated or substantiated by ultrasound, so that in a positive case preparations can be made for an operation soon after birth. As a rule, newborns recover quickly after the operation, so that a certain normality sets in just a few days after the operation, which no longer requires an adjustment of behavior in everyday life, provided that the functional capability of the intestine could be established during the surgical procedure.
