Management of jejunoileal atresias: an experience at eastern Nepal.
BACKGROUND
Intestinal atresia is a common cause of neonatal intestinal obstruction, and management of this disease in limited setup of a developing country is very difficult.


METHODS
This study is a retrospective study of patients with jejunoileal atresias and their postoperative outcome in a teaching hospital in eastern Nepal over a 5-year period.


RESULTS
There were 28 children (19 boys and 9 girls). 11 children (39.28%) had jejunal atresia and 17 (60.71%) had ileal atresia. Eight (28.5%) patients died, 6 were jejunal atresia (54.5%) and 2 were ileal atresia (11.7%). The most common cause of death was sepsis which occurred in 7 out of 8 cases (87.5%). The risk factors for mortality identified were leucopenia, neutropenia, delay in surgery, location of atresia and type of atresia. Jejunal atresia tended to have a higher mortality than ileal atresia, and severe types of atresia (type IIIb and IV) were more often associated with mortality than other types of atresia. The significant differences between jejunal and ileal atresia were the increased duration between presentation and surgery, longer postoperative and total hospital stay, presence of more severe atresias and an increased risk of mortality in case of jejunal atresias.


CONCLUSIONS
The prognosis for this disease have definitely changed in the last few decades in developed countries but in our environment, problems like late presentation and diagnosis, lack of availability of good neonatal intensive care units and parenteral nutritional support still prevail.
Department of Surgery, B, P, Koirala Institute of Health Sciences, Dharan, Nepal. vikalcsh@yahoo.com
Vikal C
VC
Shakya
Chandra S
CS
Agrawal
Pramod
P
Shrestha
Prakash
P
Poudel
Sudeep
S
Khaniya
Shailesh
S
Adhikary
D005260:Female; D006801:Humans; D007082:Ileum / Q000002:abnormalities* / Q000601:surgery; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D007583:Jejunum / Q000002:abnormalities* / Q000601:surgery; D008297:Male; D009390:Nepal; D012189:Retrospective Studies; D016896:Treatment Outcome