Yıl: 2021 Cilt: 22 Sayı: 1 Sayfa Aralığı: 19 - 24 Metin Dili: İngilizce DOI: 10.4274/imj.galenos.2020.98957 İndeks Tarihi: 29-07-2022

Intestinal Atresia: Twenty Years of Experience at a Reference Hospital

Öz:
Introduction: The aim of this study was to reveal the factors that affect the clinical outcomes of patients undergoing surgery in our university hospital for intestinal atresia (IA) and to share our experience. Methods: We analyzed data from 74 newborns with IA who underwent surgical treatment between January 1997 and December 2016.Results: The study population consisted of 40 female and 34 male newborns with a mean age at diagnosis of 6.4±8.3 days. The mean birth weight was 2.3±0.6 kg, the mean gestational age was 35.6±2.8 weeks, the mean maternal age was 28.9±6.1 years, and the mean hospitalization time was 24.5±25.3 days. Duodenal atresia was the most common diagnosis (n=31, 42%) and colonic atresia the least common (n=2, 3%). The longest and shortest mean hospital stays occurred in patients with jejunal (32.8±41.6 days) and those with colonic (8±0 days) atresia, respectively. Although the survival rates were low in newborns with either intestinal or duodenal atresia (80% or 81%, respectively), all patients with pyloric or colonic atresia survived. Of the patients who died, 82% (9/11) had additional congenital abnormalities (X2 =8.461, p=0.004), which includedmajor cardiac defects (n=3), Down syndrome (n=2), biliary atresia (n=1), esophageal atresia + tracheoesophageal fistula + anal atresia + tracheal atresia (n=1), esophageal atresia + tracheoesophageal fistula (n=1), and microcephaly (n=1).The mean hospital stay of patients with or without additional abnormalities was 26.4±21.4 or 23.04±28.04 days, respectively (p=0.207). Conclusion: Among newborns with IA, duodenal atresia was the most common diagnosis and colonic atresia the least common. Additional congenital abnormalities negatively affect the hospital stay and mortality rate of newborns with IA.
Anahtar Kelime:

İntestinal Atrezi: Referans Bir Hastanenin Yirmi Yıllık Deneyimi

Öz:
Amaç: Bu çalışmada, bir üniversite hastanesinde intestinal atrezi (İA) endikasyonu ile ameliyat edilen hastaların klinik sonuçlarına etkili olan faktörleri ortaya koymak ve deneyimlerimizi paylaşmak amaçlanmıştır. Yöntemler: Ocak 1997-Aralık 2016 tarihleri arasında cerrahi tedavi uygulanan 74 İA’lı yenidoğan olgu çalışmaya alındı. Bulgular: Çalışma popülasyonu, tanı anındaki ortalama yaşı 6,4±8,3 gün olan 40 kız ve 34 erkek yenidoğandan oluşuyordu. Ortalama doğum ağırlığı 2,3±0,6 kg, gebelik yaşı 35,6±2,8 hafta, anne yaşı 28,9±6,1 yıl ve hastanede kalış süresi 24,5±25,3 gündü. En fazla duodenal atrezi (n=31, %42), en az ise kolon atrezisi (n=2, %3) görüldü. En uzun ve en kısa ortalama hastanede kalış süreleri sırasıyla jejunal atrezili (32,8±41,6 gün) ve kolonik atrezili (8±0 gün) olgularda saptandı. Sağkalım oranları multipl İA’da ve duodenal atrezide düşük (sırasıyla; %80 ve %81) olmasına karşın pilorik atrezili ve kolonik atrezili tüm olgular hayatta kaldı. Ölen hastaların %82’sinde (9/11) ek konjenital anomaliler vardı (X2 =8,461, p=0,004). Bunlar majör kardiyak defektler (n=3); Down sendromu (n=2), biliyer atrezi (n=1) ve özofagus atrezisi + trakeoözofageal fistül + anal atrezi + trakeal atrezi (n=1), özofagus atrezisi + trakeoözofageal fistül (n=1) ve mikrosefali (n=1). Ek anomalisi olan ve olmayan hastaların ortalama hastanede kalış süresi sırasıyla 26,4±21,4 gün ve 23,04±28,04 gündü (p=0,207). Sonuç: İA’lar arasında en sık duodenal atrezi, en az ise kolonik atrezi görüldü. Ek konjenital anomaliler İA’lı yenidoğanlarda hastanede kalış süresini ve mortalite oranını olumsuz etkilemektedir.
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Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Forrester MB, Merz RD. Population-based study of small intestinal atresia and stenosis, Hawaii, 1986-2000. Public Health 2004; 118: 434-8.
  • 2. Grosfeld JL, Ballantine TV, Shoemaker R. Operative management of intestinal atresia and stenosis based on pathologic findings. J Pediatr Surg 1979; 14: 368-75.
  • 3. Gupta S, Gupta R, Ghosh S, Gupta AK, Shukla A, Chaturvedi V, et al. Intestinal atresia: experience at a busy center of North-West India. J Neonatal Surg 2016; 5: 51.
  • 4. Gross RE. Congenital atresia of the intestine and colon. In: Gross RE, editor. The Surgery of Infancy and Childhood: Its Principles and Techniques. Philadelphia (PA): WB Saunders; 1953. p. 150-66.
  • 5. Akkoyun İ, Erdoğan D, Cavuşoğlu YH, Tütün O. What is our development progress for the treatment outcome of newborn with intestinal atresia and stenosis in a period of 28 years? N Am J Med Sci 2013; 5: 145-8.
  • 6. Kumaran N, Shankar KR, Lloyd DA, Losty PD. Trends in the Management and Outcome of Jejuno-Ileal Atresia. Eur J Pediatr Surg 2002; 12: 163-7.
  • 7. Chirdan LB, Uba AF, Pam SD. Intestinal atresia: management problems in a developing country. Pediatr Surg Int 2004; 20: 834-7.
  • 8. Ekenze SO, Ibeziako SN, Ezomike UO. Trends in neonatal intestinal obstruction in a developing country, 1996-2005. World J Surg 2007; 31: 2405-9.
  • 9. Chadha R, Sharma A, Roychoudhury S, Bagga D. Treatment strategies in the management of jejunoileal and colonic atresia. J Indian Assoc Pediatr Surg 2006; 11: 79-84.
  • 10. Basu R, Burge DM. The effect of antenatal diagnosis on the management of small bowel atresia. Pediatr Surg Int 2004; 20: 177-9.
  • 11. Nijs E, Callahan MJ, Taylor GA. Disorders of the pediatric pancreas: imaging features. Pediatr Radiol 2005; 35: 358-73.
  • 12. Escobar MA, Ladd AP, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd, et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg 2004; 39: 867-71.
  • 13. Rattan KN, Singh J, Dalal P. Neonatal duodenal obstruction: A 15-year experience. J Neonatal Surg 2016; 5: 13.
  • 14. Chen QJ, Gao ZG, Tou JF, Qian YZ, Li MJ, Xiong QX, et al. Congenital duodenal obstruction in neonates: a decade’s experience from one center. World J Pediatr 2014; 10: 238-44.
  • 15. Zamir N, Akhtar J. Neonatal duodenal obstruction: clinical presentation and outcome. J Surg Pakistan (Int) 2013; 18: 182-5.
  • 16. Bodian M, White LLR, Carter CO, Louw JH. Congenital duodenal obstruction and mongolism. Br Med J 1952; 1: 77-9.
  • 17. Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 1998; 133: 490-6.
  • 18. Walker K, Badawi N, Hamid CH, Vora A, Halliday R, Taylor C, et al. Neonatal Intensive Care Units’ (NICUS) Group, NSW Pregnancy and Newborn Services Network. A population-based study of the outcome after small bowel atresia/ stenosis in New South Wales and the Australian Capital Territory, Australia, 1992-2003. J Pediatr Surg 2008; 43: 484-8.
  • 19. Stollman TH, de Blaauw I, Wijnen MH, van der Staak FH, Rieu PN, Draaisma JM, et al. Decreased mortality but increased morbidity in neonates with jejunoileal atresia; a study of 114 cases over a 34-year period. J Pediatr Surg 2009; 44: 217-21.
  • 20. Singh V, Pathak M. Congenital neonatal intestinal obstruction: retrospective analysis at tertiary care hospital. J Neonatal Surg 2016; 5: 49.
  • 21. Etensel B, Temir G, Karkiner A, Melek M, Edirne Y, Karaca I, et al. Atresia of the colon. J Pediatr Surg 2005; 40: 1258-68.
  • 22. Piper HG, Alesbury J, Waterford SD, Zurakowski D, Jaksic T. Intestinal atresia: factors affecting clinical outcomes. J Pediatr Surg 2008; 43: 1244-8.
  • 23. Stoll C, Alembik Y, Dott B, Roth MP. Evaluation of prenatal diagnosis of congenital gastro-intestinal atresia. Eur J Epidemiol 1996; 12: 611-6.
  • 24. Miro J, Bard H. Congenital atresia and stenosis of the duodenum: the impact of a prenatal diagnosis. Am J Obstet Gynecol 1988; 158: 555-9.
  • 25. Calisti A, Olivieri C, Coletta R, Briganti V, Oriolo L, Giannino G. Jejunoileal atresia: factors affecting the outcome and long-term sequelae. J Clin Neonatol 2012; 1: 38-41.
APA SARAÇ M, TARTAR T, Bakal U, Aydin M, akdeniz i, Kazez A (2021). Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. , 19 - 24. 10.4274/imj.galenos.2020.98957
Chicago SARAÇ Mehmet,TARTAR TUGAY,Bakal Unal,Aydin Mustafa,akdeniz ibrahim,Kazez Ahmet Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. (2021): 19 - 24. 10.4274/imj.galenos.2020.98957
MLA SARAÇ Mehmet,TARTAR TUGAY,Bakal Unal,Aydin Mustafa,akdeniz ibrahim,Kazez Ahmet Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. , 2021, ss.19 - 24. 10.4274/imj.galenos.2020.98957
AMA SARAÇ M,TARTAR T,Bakal U,Aydin M,akdeniz i,Kazez A Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. . 2021; 19 - 24. 10.4274/imj.galenos.2020.98957
Vancouver SARAÇ M,TARTAR T,Bakal U,Aydin M,akdeniz i,Kazez A Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. . 2021; 19 - 24. 10.4274/imj.galenos.2020.98957
IEEE SARAÇ M,TARTAR T,Bakal U,Aydin M,akdeniz i,Kazez A "Intestinal Atresia: Twenty Years of Experience at a Reference Hospital." , ss.19 - 24, 2021. 10.4274/imj.galenos.2020.98957
ISNAD SARAÇ, Mehmet vd. "Intestinal Atresia: Twenty Years of Experience at a Reference Hospital". (2021), 19-24. https://doi.org/10.4274/imj.galenos.2020.98957
APA SARAÇ M, TARTAR T, Bakal U, Aydin M, akdeniz i, Kazez A (2021). Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. İstanbul Medical Journal, 22(1), 19 - 24. 10.4274/imj.galenos.2020.98957
Chicago SARAÇ Mehmet,TARTAR TUGAY,Bakal Unal,Aydin Mustafa,akdeniz ibrahim,Kazez Ahmet Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. İstanbul Medical Journal 22, no.1 (2021): 19 - 24. 10.4274/imj.galenos.2020.98957
MLA SARAÇ Mehmet,TARTAR TUGAY,Bakal Unal,Aydin Mustafa,akdeniz ibrahim,Kazez Ahmet Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. İstanbul Medical Journal, vol.22, no.1, 2021, ss.19 - 24. 10.4274/imj.galenos.2020.98957
AMA SARAÇ M,TARTAR T,Bakal U,Aydin M,akdeniz i,Kazez A Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. İstanbul Medical Journal. 2021; 22(1): 19 - 24. 10.4274/imj.galenos.2020.98957
Vancouver SARAÇ M,TARTAR T,Bakal U,Aydin M,akdeniz i,Kazez A Intestinal Atresia: Twenty Years of Experience at a Reference Hospital. İstanbul Medical Journal. 2021; 22(1): 19 - 24. 10.4274/imj.galenos.2020.98957
IEEE SARAÇ M,TARTAR T,Bakal U,Aydin M,akdeniz i,Kazez A "Intestinal Atresia: Twenty Years of Experience at a Reference Hospital." İstanbul Medical Journal, 22, ss.19 - 24, 2021. 10.4274/imj.galenos.2020.98957
ISNAD SARAÇ, Mehmet vd. "Intestinal Atresia: Twenty Years of Experience at a Reference Hospital". İstanbul Medical Journal 22/1 (2021), 19-24. https://doi.org/10.4274/imj.galenos.2020.98957