[Colonic atresia. Which surgical treatment?].
We report seven cases of congenital colonic atresia over a 13 year period (1975-1988). The atresia was located in the ascending or transverse colon (4 cases), or in the descending or sigmoid colon (3 cases). According to Bland-Sutton classification, one patient was a type I, five were either a type II or III, and for the last patient the type was not precise. Three infants had associated malformations: jejunal atresia (case n. 6), intestinal malrotation (case n. 5), and gastroschisis and jejunal atresia. This last patient, in whom jejunal and colonic atresias were autopsy findings, died after a Schuster procedure for gastroschisis closure. The six other neonates survived. Five of them underwent emergency colostomy and delayed anastomosis when general conditions were stable (2 to 10 months after colostomy). The sixth neonate (case n. 2) was treated by colonic resection and primary ileocolic anastomosis. Two patients had postoperative complications, ie, anastomotic leak (case n. 4) or disfunction (case n. 2), which were successfully treated by another operation. The outcome, one year after the onset of the disease, was good for 5 out of the 6 survivors. All these five patients were normally passing stools, once or twice a day, with no abdominal distension. One patient (case n. 6) had a short bowel syndrome secondary to a jejunal atresia, with intermittent watery stools and abdominal distention. We reviewed the 161 cases of colonic atresia from English and French experience since 1960. The overall mortality rate is 25%. Associated malformations and infection are the main causes of death. The rate of anastomotic complications is high (15%).(ABSTRACT TRUNCATED AT 250 WORDS)
Levard
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Clinique chirurgicale, Hôpital Jean-Bernard, CHRU La Milétrie, Poitiers.
Boureau
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D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy; D003106:Colon / Q000002:abnormalities* / Q000601:surgery; D003109:Colonic Diseases, Functional / Q000209:etiology; D003125:Colostomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007081:Ileostomy; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000145:classification / Q000601:surgery*; D007583:Jejunum / Q000002:abnormalities; D008297:Male; D011183:Postoperative Complications; D018805:Sepsis / Q000209:etiology
Atrésies coliques. Quel traitement chirurgical?