Under a Dünndarmatresie a developmental disorder of the small intestine is understood. The lumen of the empty intestine or ileum are not continuous.
What is small intestinal atresia?
Small intestinal atresia is a disease of the small intestine (intestinum tenue) that is already congenital. The small intestine is composed of the ileum (ileum) and the jejunum (jejunum) together and is not continuous. The reason for a small intestine atresia is the bag-like bulging of a membrane into the intestine or a so-called true atresia, in which part of the intestine is missing.
According to phonecations, the incidence of small intestinal atresia is estimated at 1.3 in 10,000. Medicine divides atresia of the small intestine into several forms. Type I has a bulging membrane. Type II is when there are blind ends that are connected by a connective tissue band. In the case of Type IIIa, the blind ends have no connection. Type IIIb is also known as the apple peel deformity. Doctors speak of type IV when there are several atresias in a row.
Causes
Atresia of the small intestine is usually caused intrauterine due to a so-called vascular accident. The reason for this is often a small blood clot, which means that part of the small intestine no longer receives enough blood. In older children or adults, this would lead to an intestinal infarction, which is classified as a medical emergency.
In unborn children, however, this process takes an intrauterine course. This means that the child’s mother doesn’t even notice him. Because of this, it is not always easy to identify small intestinal atresia before birth.
Symptoms, ailments & signs
Small intestinal atresia usually only becomes noticeable after birth. The affected children suffer from an intestinal obstruction (ileus). At the onset of the disease, the babies still look healthy. However, because the food cannot be passed on within the intestine, vomiting is usually bilious.
Due to the innate disruption of bowel continuity, the contents of the bowel build up. How far the baby’s stomach will expand depends on the length of the interruption. There is little or no deposition of meconium (newborn stool).
Depending on how pronounced the defect in the intestine is, sooner or later it leads to vomiting. In some cases the vomit takes on a stupid consistency. If the diagnosis of small intestinal atresia is made too late, there is a risk of perforation (through hole) in the small intestine, which in turn results in severe inflammation in the abdomen.
Diagnosis & course
Atresia of the small intestine is a medical emergency and requires immediate medical examination and treatment. If there is a suspicion of small intestinal atresia, an ultrasound examination can take place before the birth. This is the case when expanded intestinal loops can be displayed constantly.
It is also possible that there is an above-average amount of amniotic fluid (hydramnios), which is an indication of small intestinal atresia. After birth, it is difficult to build up food and the affected babies suffer from bilious vomiting. The higher the stenosis (constriction), the earlier the vomiting begins.
If the stenosis is deep, the doctor can recognize the atresia by a bulging abdomen. If there is a suspicion of atresia of the small intestine after the child is born, an x-ray of the abdomen is carried out. It may be necessary to take a contrast agent.
Prompt treatment is important for the course of small intestinal atresia. This always takes the form of an operative intervention. If the therapy takes place at the right time, the prognosis is positive. It usually takes a few days after the operation for the bowel to return to normal.
Complications
In the worst case, the atresia of the small intestine can lead to a so-called intestinal obstruction. This is a very dangerous condition for the human body and must be avoided in any case. Vomiting often occurs, and it is not uncommon for the affected person to vomit bile. The patient’s stomach also feels bloated and there is no longer any appetite.
The rupture of the intestine can cause serious inflammation and infections in the abdomen, which can lead to serious complications. Without treatment, the atresia of the small intestine can even lead to death. Treatment is symptomatic in most cases. However, it is not possible in all cases to treat the consequences and symptoms of small intestinal atresia.
It is not uncommon for the patient to then have to rely on an artificial anus, which extremely reduces the quality of life. The operation itself is usually carried out without complications. However, everyday life is made more difficult for those affected by the small intestinal atresia.
Sports and physical activities can usually no longer be taken up. Life expectancy is not affected if early treatment is carried out. In most cases, children can recover from the disease quickly.
When should you go to the doctor?
Small intestinal atresia is a medical emergency and must be clarified and treated immediately. The disease is usually diagnosed immediately after birth and treated on site. Occasionally, atresia of the small intestine can be detected before birth. The doctor responsible will inform the parents of the child concerned about the developmental disorder and prepare the postnatal operation. A weakly developed small intestinal atresia, on the other hand, is often only recognized after leaving the clinic.
In the event of complications such as vomiting or intestinal obstruction, parents should go to the nearest clinic as soon as possible. In the event of an intestinal rupture, an emergency doctor must be alerted. If left untreated, small intestinal atresia can be fatal.
Therefore, medical advice should be sought at the first signs of atresia of the small intestine. Further follow-up visits are indicated after the surgery to correct the small intestine. Which measures make sense in detail depends on the individual complaints and should always be discussed with the responsible doctor.
Treatment & Therapy
Surgical intervention is unavoidable for the successful treatment of small intestinal atresia. Due to the different forms of expansion of the intestine, the doctor must decide before the operation whether to sew the two remaining ends of the intestine together immediately after removing the constriction, or to first create an artificial anus. This may be necessary, for example, if the diameters between the intestinal sections differ too much.
The artificial anus is called the protective stroma and has a protective function. He is usually moved back about three to four months after the operation. The first step in the operation is to open up the abdomen.
The surgeon will then carefully examine the bowel to find any additional abnormalities and treat them if necessary. In most cases there is a marked expansion of the upper part of the intestine. In contrast, the still unused lower portion is mostly stunted and has only a small intestinal lumen.
An oblique anastomosis technique must be used to connect both parts. Most surgeries are open surgery. This means that an abdominal incision takes place. Minimally invasive treatment for atresia of the jejunum cannot be undertaken.
After the operation, the baby will be monitored by intensive care medicine. Breast milk is recommended as a food intake, the amount of which increases carefully. It can take some time for the intestinal tract to be fully functional. In most cases, however, the children recover quickly.
Outlook & forecast
Without medical care, the baby has a poor prognosis. With atresia of the small intestine, surgical intervention is essential, otherwise intestinal obstruction will result. This can lead to an intestinal rupture and thus to a life-threatening condition.
The prognosis is much better for newborns who are treated immediately. The congenital malformation is corrected in an operation. Doctors also create an artificial anus to ensure the patient’s survival. The baby will be monitored by intensive care for some time and all functions will be checked.
After several months, the intestines gradually begin to function naturally. With this approach, the healing process is tedious and often difficult to cope with for relatives and the newborn. Nevertheless, there are ultimately good prospects of recovery on this path. In many cases, a second procedure is necessary and the artificial anus is removed. Once the intestine is fully functional, the patient is discharged from the treatment. Check-ups are usually not necessary.
If the scarring results in discomfort or pain in the later course, a new treatment is carried out with laser therapy. This does not change the good prognosis for small intestinal atresia. The patient can have symptom-free bowel movements for life.
Prevention
It is not possible to prevent small intestinal atresia. So it is an already congenital malformation.
You can do that yourself
Small intestinal atresia involves a rare malposition of the small intestine in newborns. All known forms of atresia have in common that the small intestine is either closed at one or more places or has no connection to the continuing intestinal sections.
This means that the contents of the small intestine cannot be passed on. In principle, it is a directly threatening condition of an intestinal obstruction that requires surgical treatment as quickly as possible. An adaptation of the behavior in everyday life does not make sense due to the urgency of the treatment of the newborn.
The main aim of the parents should be to have the affected newborn baby examined and operated on by experienced specialist surgeons in an appropriate specialist clinic, otherwise the prognosis for the disease, which occurs rarely, will noticeably deteriorate. Efficient self-help measures do not exist, because regardless of the appearance of the small intestinal atresia, the intestinal’s insufficient permeability can only be achieved by surgical-mechanical means.
If there are indications that small intestinal atresia is suspected before birth, the suspicion can be refuted or corroborated by ultrasound, so that, in the positive case, preparations can be made for an operation soon after the birth. As a rule, the 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 adaptation of the behavior in everyday life, provided that the functional efficiency of the intestine could be restored during the operation.
