Intestinal atresia

Intestinal atresia is a common cause of congenital intestinal obstruction and usually presents in a stable patient with emesis in the first 48 h of life. An abdominal radiograph demonstrates obstruction and will suggest the level of the atresia. A contrast enema can aid in the diagnosis of a distal ileal or colonic atresia and assist in the assessment for more distal additional atresias. Preoperative management includes orogastric tube decompression, fluid resuscitation, and broad-spectrum antibiotics if perforation or ischemia is suspected. Distal obstruction should be ruled out intraoperatively by flushing the distal limb. Primary anastomosis can be safely performed in most cases unless there is contamination from perforation or the bowel has questionable viability. Size discrepancy of the two ends can be managed with a short segmental resection or tapering enteroplasty. Colonic atresia is similarly resected and primarily anastomosed, but should also include rectal biopsy to rule out Hirschsprung’s disease. In cases of significant size mismatch of colonic segments, colostomy can be performed with later anastomosis. Patients should be monitored for return of bowel function and then diet advanced. Long-term outcomes are good with >90 % survival.