Intestinal atresia with gastroschisis: a selective approach to management.
BACKGROUND
The association of bowel atresia with gastroschisis is well recognized, but the ideal management is less certain.


METHODS
The records of 10 infants with gastroschisis and intestinal atresia treated between 1991 and 1997 in a single neonatal surgical unit were reviewed.


RESULTS
Ten infants had midgut atresias: 5 small intestine, 1 jejunum and colon, and 4 colonic. Of the 6 with small bowel atresias, 4 had primary abdominal wall repair with electively delayed primary anastomosis at 21 to 46 days, 1 had decompressing tube jejunostomy at 11 days at the time of secondary abdominal closure, and 1 initial jejunostomy. Of the 4 with colonic atresia alone, 3 had perforation or infarction of the proximal colon at birth, 2 had a primary stoma, and 2, who did not have initial colostomy or anastomosis, required reoperation for increasing abdominal distension at 11 and 23 days. Complications were recorded in 6 patients: 2 had necrotizing enterocolitis after which 1 developed malabsorption, 1 had distal bowel obstruction after delayed primary anastomosis treated with a Bishop-Koop ileostomy at 50 days, 2 had stoma stenosis, and 1 had stoma prolapse. None died, and at 1 year 9 were within the normal range for body weight, and details of 1 are not known.


CONCLUSIONS
At birth, diagnosis of atresia often is uncertain, and the bowel is difficult to repair or exteriorize. For proximal atresias, delayed primary repair is a safe satisfactory approach. At birth, distal atresias are more obvious, often complicated by perforation or infarction, and may benefit from early enterostomy.
Fleet
M S
MS
Department of Paediatric Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, England.
de la Hunt
M N
MN
D004739:England / Q000453:epidemiology; D004766:Enterostomy / Q000379:methods / Q000401:mortality; D020139:Gastroschisis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome