Type lllb jejunal atresia: the experience of two training hospitals in Johannesburg

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.