Type lllb jejunal atresia: the experience of two training hospitals in Johannesburg
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Date
2019
Authors
Singh, Shalin
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Abstract
Introduction
Type IIIb jejunal atresia is reported to be the least common of all the small
bowel atresias. It is also reported to have the worst prognosis of all types of
jejunal atresia. This is because babies are born preterm or small for
gestational age, with congenitally foreshortened bowel, and a single artery to
perfuse the distal small bowel, this in a retrograde fashion. The current theory
for gap and cord type atresias does not result in apple peel atresias in
experimental models. This will be the largest published series of Type IIIb
atresias to date.
Aims
To report the incidence of Type IIIb jejunal atresia at the two academic
hospitals in Johannesburg and to look for statistically significant similarities in
the cohort of jejunoileal atresias.
Objectives
To collect data from the paediatric surgery database and patient files.
To work with the collected data, if patient similarities are found, and apply
statistical analysis with the help of a statistician.
Methods
We performed a retrospective chart review of all patients with a confirmed
diagnosis of jejunoileal atresia admitted to the Department of Paediatric
Surgery over 59 months.
Results
We operated on 113 cases of jejunoileal atresia. 17 patients were excluded.
96 patients were collected. Type IIIb jejunal atresia made up 32% (n=31) of
the study group. 39% of those (n=12) had multiple atresias. Perforation and
volvulus were found in 6% and 16% of the patients respectively. All patients
with volvulus were found to have necrosis of the entire midgut and required
palliative care. When comparing the apple peel atresias to the cord and gap
types, there was no significant difference in the prevalence of multiple atresias
(p=0.18), the prevalence of perforation (p=0.26) or the time to full feeds
(p=0.10)
Conclusion
Type IIIb atresia is not rare in our environment. Volvulus is significantly more
common in Type IIIb atresia and carries a 100% mortality rate.
Description
MMed in Paediatric Surgery
2019
Keywords
Citation
Singh, Shalin Maria (2019) Type IIIb Jejunal Atresia:the experience of two training hospitals in Johannesburg, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29932>