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Intestinal Atresia

What is intestinal atresia? 


Intestinal atresia is a blockage in the intestine. It may occur when there is not enough blood flow to the intestines during development. Some sections of the intestine may not connect to one another. This blockage is usually in the small intestine (jejunum or ileum). The large intestines are rarely involved. It is possible, but uncommon, for more than one blockage to be present.

What causes intestinal atresia?


Intestinal atresia may be caused when there is not enough blood flow to the intestines during development. Due to this, the affected intestine either scars or may be reabsorbed. The problem happens late in pregnancy and is not typically linked with other conditions.

What are the symptoms of intestinal atresia?


Your doctor will sometimes diagnose intestinal atresia during your pregnancy. A blockage that is high in the intestine can cause a condition called polyhydramnios, or too much amniotic fluid. However, it is more common for the condition to be found in the first few days after your baby is born, when your baby has dark green vomit or unusual stools (poop). As your baby swallows more air and begins to take feedings, their belly becomes enlarged and they will vomit.

Doctors diagnose intestinal atresia with an X-ray that shows dilated (narrowed) intestinal loops. They may confirm the diagnosis with a barium enema, which is a special X-ray of the large intestine. This X-ray generally shows that your baby has a smaller-than-usual colon (the lower part of the bowel) because the blockage in the upper bowel prevented the colon from developing correctly.

What is the treatment for intestinal atresia?


If your baby is diagnosed with intestinal atresia, they will need to have surgery soon after birth. The surgery involves removing the blockage and putting the intestine back together. Since the intestine is dilated and not working, some of the dilated segment is taken out. If possible, the intestine is reconnected (an anastomosis). Sometimes there is a large difference in size between the intestine located before and after the obstruction and reconnection is not possible.

In cases where the intestine cannot be reconnected, a hole is made in the abdomen and the intestine is then attached to this hole (called a stoma). The goal is to allow the intestine to decrease in size and promote the growth of the lower intestine that is left in the abdomen. Once both ends of the intestine are comparable in size — usually several months later — your baby is returned to the operating room for the reconnection of the two ends of the intestine and closure of the abdominal stoma.

Before and after surgery, a nasogastric tube (NG) is placed through the nose or mouth into the stomach to prevent the intestine from filling with air and to remove fluid. This will stay in place until the intestinal function returns. Feedings are carefully started after signs that the bowel is working properly. These signs include clear and decreasing NG output, the abdomen is no longer enlarged, and passing gas or stool. Feedings are started and then slowly increased through a feeding tube that drips milk into the stomach. Reaching full feedings by mouth may take several days or longer (sometimes months). While your baby cannot receive feedings, nutrition is provided through an IV line.

Mothers who plan to breastfeed are encouraged to pump breast milk that will be frozen and stored until the child is able to receive feedings.

The length of stay in the NICU for an infant with this condition varies. Your baby will be able to go home when they can tolerate full feedings and are gaining weight. After discharge, a pediatrician will monitor your baby. Your baby will also come back to Children’s Mercy to see the pediatric surgeon or any other necessary specialists.

What is the expected outcome and complications?

 

Overall survival for this condition is excellent (greater than 95 percent). Though complications are uncommon, the complications linked with this condition are a leak or narrowing (stricture) where the intestines were reconnected, intestinal dysfunction or short bowel syndrome.

Why choose Children’s Mercy?

 

At Children’s Mercy your baby will be cared for by a team of highly experienced specialists that will work to ensure your baby is getting adequate nutrition and growing appropriately. Our surgeons are the most experienced in the region in treating intestinal atresia. We have specialists who will follow your baby to ensure the intestines are working and they are getting enough nutrition, even after you go home.

Neonatal Follow-Up Clinics: Care for your growing child

We recognize that many of our NICU graduates have special health care needs related to growth and development. The Neonatal Follow-Up Clinics provide follow-up services for your babies after they're home from the NICU.