Intestinal Atresia

Definition

Intestinal atresia is present at birth. It is an area of the intestine that has not formed correctly. In some, the intestine may be completely closed off. Atresia makes it impossible for food or fluids to pass through.

Atresia can happen in the small or large intestines and may be named by the location:

• Pyloric atresia—just after the stomach
• Duodenal atresia—first portion of small intestine by the stomach
• Jejunal atresia—small intestine between upper and lower portions
• Ilial atresia—occurs in last portion of small intestine
• Colonic atresia—occurs in large colon

Normal Anatomy of the Intestines

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Causes

It is not exactly clear what causes intestinal atresia. Low blood flow to the intestines during development may play a role.

Risk Factors

Some types of atresia have a genetic link. They tend to occur in families.

Risk factors of jejuno-ileal atresia include use of tobacco or cocaine during pregnancy.

Symptoms

Atresia may cause extra fluid to surround the baby during pregnancy.

After birth, symptoms in the baby may include:

• Vomiting
• Swelling of the abdomen
• Lack of a first stool
• Lack of interest in feedings

Diagnosis

A prenatal ultrasound will be able to detect extra fluid around the baby. The doctor may suspect the extra fluid is due to atresia. More tests will be planned after birth to confirm the diagnosis.

After birth, your child’s doctor will review your child’s symptoms. Images of the intestines will be taken to confirm the diagnosis and locate the atresia. Tests that will help create images of the intestines include:

• Abdominal X-ray
• Upper gastrointestinal (GI) series
• Lower GI series

Some types of atresia are associated with other health problems. To look for other related problems the doctor may order:

• An echocardiogram of the heart
• Prenatal genetic screening such as amniocentesis
• Images of the kidney
• A sweat chloride test to check for cystic fibrosis

Treatment

Intestinal atresia cannot be treated until after birth.

Treatment will include surgery to repair the intestine and supportive care.

Nutrition Support

Nutrition normally enters the body through the intestines. Since the intestines are not working properly, nutrition will be delivered directly into the blood stream. Your baby will have an IV or small belly button tube. Nutrition will be delivered through the tube before and after surgery.

After surgery, the intestines will need a few days or weeks to heal. Small amounts of breast milk or formula will be slowly introduced to your baby. IV nutrition will continue to support your baby during this transition. The IV will be removed when your baby can tolerate enough breast milk or formula.

Remove Gas and Fluids

Fluid and gas can build up in the intestine. They can cause uncomfortable swelling in the abdomen and vomiting. The fluid and gas can cause complications during surgery.

A tube will be passed through the nose and into the stomach. The tube will drain fluids and gas out of the stomach and intestines. This will relieve some of the pressure in the abdomen.

Surgery

Surgery will be needed to remove the damaged part of the intestine. The healthy parts of the intestine will be reconnected. Additional steps may depend on the amount of intestine that is damaged. A large area may need more than one surgery.

A feeding tube may be placed through the abdomen. This tube will help drain the stomach and deliver food.

Surgery in the lower intestine may also require a colostomy. The upper part of the remaining intestine is attached to an opening in the abdominal wall. This will allow waste to pass out of the body and give the lower intestines time to heal.

Most babies do well after surgery. Follow-up care will ensure that the intestines are working as expected.

Prevention

There are no current guidelines to prevent intestinal atresia. There may be a link between atresia and smoking and cocaine during pregnancy.