INTRODUCTION :
Intestinal atresia is one of the most common surgical disease in
neonates. Jejunoileal atresia occurs more frequently than duodenal or colonic
atresia. It accounts 30% of all cases of neonatal intestinal obstruction. The
incidence of jejunoileal atresia varies between 1/300 and 1/3000 live birth.
Ravitch et al estimated the over all incidence of intestinal atresia at 1 per
2719 live birth. Boys and girls are equally affected. Down Syndrome is
most uncommon in babies with jejunoileal atresia compared with duodenal
atresia.
The intestine proximal to obstruction is usually dilated and
hypertrophied and has a cynosed appearance and may have patches of
necrotic areas. The peristaltic movement in this segment is subnormal and
ineffective.
The distal bowel is unused and worm like, potentially normal in length
and function. If the atresia has occured late in intrauterine life the bowel
distal to atresia have a near normal calibre.
At the level of atresia, the ganglion of the enteric nervous system are
atrophic and hypocellular. These changes are most likely the result of
ischemia.
Intestinal dysmotility is an important problem in the post operative
management of patients with jejunoileal atresia. The alterations of neural and
muscular elements and the extent of histologic changes proximal and distal
to atresia may contribute to the postoperative intestinal dysmotility in these
cases, but the etiology of this disease is not yet to be understood4.
The distended proximal bowel produces a significant technical
problem for anastomosis and also predisposes to the intestinal dysmotility as
it is deficient of muscular and neural elements.
The operative techniques and medical treatments, including nutritional
therapy, have led to an improvement in the outcome of patients with
intestinal atresia, some problems related to the management of intestinal
atresia still remain unresolved.
The post operative intestinal dysmotility is frequently associated with
dilatation of the proximal intestinal segment but its etiology is not yet fully
understood. Hypoplasia of intramural nerves and pacemaker cells and
abnormal musculature in the proximal segment of jejunoileal atresia were
accepted as causative factors for intestinal dysmotility.
AIM :
The aim of this study is to investigate the possible etiological factors
of Jejunoileal atresia by evaluating the resected specimen
histopathologically, regarding the histological structure of intestinal
muscular layer and myentric plexuses.
MATERIALS AND METHODS :
For this study, Patients with complaints of Abdominal distension,
Bilious vomiting and not passed Meconium were chosen. Patients admitted to
the Paediatric Surgical department at ICH & HC, Chennai, Tamil Nadu
during the period January 2007 to April 2008 were included in the study.
Totally 20 No. of patients were included for the study. This study is a
prospective study. Control tissues of Jejunum and ileum were obtained from
2 patients who underwent small bowel resection for intussusception.
Patients of age group less than one month and either sex were included
Informed consent for the study were taken in each case. The nature of
surgery is resection and end to back anastanosis. Specimen is taken 5 cm of
the proximal dilated segment and 3 cm of the distal segment. Ethical
Committee clearance was obtained from the ethical committee of ICH &
HC, Chennai.
CONCLUSION :
In our studies the proximal segment of atretic intestine showed
structural deficits.
Ganglion cells were normal.
Defect in the intestinal musculature were prominent but intestinal
mucosa was intact.
These abnormalities were seen both on the antimesentric side and
on the mesentric side, which support vascular accident as a causative
factor.
When possible adequate resection rather than tapering enteroplasty
should accompany the repair of intestinal atresia to eliminate the intestinal
segment with structural defects.
When this is not feasible sufficient tapering is preferred.
Muscular defect also present at the proximal end of distal atretic
bowel and it requires resection at the time of surgical correction of atresia.
Adynamic intestinal segment owing to insufficient resection may lead
to prolonged intestinal dysmotility in the post operative period, which may
result in sepsis and death