Congenital high intestinal obstruction in newborns. Method for treating high duodenal atresia

The main diagnostic method for suspected high intestinal obstruction is an X-ray examination, which begins with survey radiographs in a vertical position in two projections. A typical radiological symptom of “complete” high CI (atresia duodenum), is the presence of two gas bubbles with fluid levels (double bubble symptom) and the absence of gas in the underlying intestines (Fig. 6). This X-ray picture absolutely reliably confirms the diagnosis of high CI, and therefore no additional methods studies (including the use of contrast agents) are not required.

Rice. 6. Atresia of the 12th duodenum. There are 2 gas bubbles with fluid levels and no gas in the underlying bowel.

With duodenal stenosis or a membrane with a hole (partial duodenal obstruction), radiographs sometimes show a small amount of gas distal to the duodenum, while the characteristic radiological sign of duodenal obstruction (double bubble sign) may be absent. A similar radiological picture is observed with partial intestinal obstruction caused by an annular pancreas (Fig. 7).

Rice. 7 Ring-shaped pancreas. There are 2 gas bubbles and poor gas filling of the distal intestine.

In this case, it is necessary to perform a contrast study and, first of all, to exclude malrotation syndrome, which radiographically and clinically may resemble partial duodenal obstruction. However, with malrotation (as opposed to malformations of the duodenum itself), life-threatening complications caused by midgut volvulus can develop if the diagnosis is not timely. Therefore, after plain radiographs to determine the position of the colon in abdominal cavity Irrigography is performed in a direct projection. For irrigography in newborns, we use a 25-30% solution of verografin, which we prepare immediately before the examination by diluting 2.5-3 times with a 76% solution contrast agent. To fill the entire colon in full-term newborns (the first days of life), 45-60 ml of contrast agent is sufficient, in premature infants - 25-30 ml (at the rate of approximately 15-20 ml per kg of body weight).

If the colon is positioned correctly in the abdominal cavity (horseshoe-shaped), the diagnosis of malrotation syndrome with midgut volvulus can be excluded. In this case, to clarify the diagnosis, it is necessary to conduct a study of the passage of the contrast agent through the gastrointestinal tract. For this purpose, after washing the barium suspension from the colon, 15-20 ml of iodolipol or barium sulfate is injected into the child’s stomach. Delay in evacuation of contrast agent from the stomach for 2 hours and appearance on radiographs taken in vertical position, two levels in the projection of the stomach and initial department duodenum confirms the diagnosis of duodenal obstruction.

Almost all patients with high CI require preoperative preparation, which can last as long as the child’s condition requires, since with this pathology there are usually no life-threatening complications requiring emergency surgical care. It is necessary to normalize the biochemical composition of the blood (electrolytes, bilirubin, sugar, etc.), CBS, and completely eliminate the symptoms of exicosis. Calculation of liquid volume for infusion therapy and the qualitative composition of the infusate is produced in the same way as in children with pyloric stenosis (see above).

The operation of choice in children with high CI with duodenal atresia and annular pancreas is duodenoduodenoanastomosis, and with duodenal membrane - membranectomy. If the obstruction in the duodenum is located near the ligament of Treitz, then a duodenojejunostomy is performed, since creating a duodenoduodenoanastomosis in this situation is impossible.

The choice of surgical correction method is determined by the need to maximize the restoration of the normal anatomy of the affected area, which is especially important for a growing organism. Therefore, with high CI in newborns and small children, an operation that is often performed in adult patients, namely gastrojejunostomy, should not be performed, despite the fact that this intervention is technically simpler than duodenoduodenoanastomosis or duodenojejunostomy. No matter how well the gastrojejunostomy is applied, the “left” blindly ending loop of the duodenum quickly increases in size as the child grows, which can be the cause of severe dyspeptic disorders (heaviness in the abdomen, frequent belching, periodic vomiting of stagnant contents, etc.) .

For any type of surgical intervention in newborns, we try to provide ways of early start enteral nutrition, especially in connection with our very modest capabilities for long-term balanced parenteral nutrition. To do this, during surgery for duodenal obstruction, we insert two probes: one into the stomach for decompression, the other into the jejunum (beyond the anastomosis area) for insertion nutritional mixture. We leave the gastric tube open to constantly remove stagnant contents from the stomach, and through an intestinal tube on the 3rd day of the postoperative period we begin the introduction of a nutritional mixture (adapted milk formula, breast milk) micro-stream at a low speed (2 ml/hour). As the patient's condition improves, we increase the speed of micro-jet administration. When the passage through the intestines is restored (as indicated by the cessation of “stagnation” in the stomach and the appearance of colored stools), we begin feeding into the stomach, while simultaneously reducing the volume of milk introduced into the intestine. Duodenoduodenoanastomosis begins to function, as a rule, on the 6th – 7th day of the postoperative period. By 8–10 days, it is usually possible to transfer the patient to full enteral feeding through the mouth and remove the intestinal tube.

Obstruction of the duodenum can be complete (atresia) or incomplete (stenosis). The anomaly can be suspected based on prenatal data in the presence of nonspecific polyhydramnios.

Duodenal atresia is often combined with other congenital anomalies - birth defects heart, kidneys and gastrointestinal tract (esophageal atresia, tracheoesophageal fistula, anal atresia). Children with duodenal atresia are often premature, and about a third of them have Down syndrome.

Symptoms of duodenal atresia and diagnosis

In most cases, duodenal obstruction occurs distally major papilla duodenum. These infants experience bilious vomiting within a few hours of birth and during meals, in contrast to infants with proximal obstruction who experience nonbilious vomiting. A direct radiograph reveals the classic symptom of a “double bubble” as a result of distension of the stomach and proximal duodenum by gases. In the presence of atresia, no gas is detected in the distal parts of the intestine, while in case of stenosis, some gas is detected distal to the distended bowel. duodenum. Need for contrast study usually not, since swallowed air is an excellent contrast medium.

Treatment of duodenal atresia and prognosis

A nasogastric tube is inserted to decompress the stomach, and the child is given emergency fluid therapy. For reconstruction of duodenal atresia, access is made in the right upper quadrant through a transverse incision. Typical intraoperative findings are a dilated duodenum and small caliber distal bowel. Mobilization of the duodenum reveals the site of atresia or stenosis and their syntholia with the major papilla, common bile duct and vessels of the mesentery. Abrupt transition hypertrophied and dilated proximal part of the duodenum into an intestine with a wall of normal thickness indicates the presence of an occlusive membrane in the duodenum. The membrane is excised during duodenotomy from the antimesenteric side; Care must be taken to preserve the middle portion of the membrane containing the ampoule. Most often, restoration of intestinal patency is carried out with a side-to-side rhomboid duodenostomy between the widened proximal part and the narrowed distal part of the duodenum. In the postoperative period, a central catheter is installed for parenteral nutrition. Within 2 weeks in the postoperative period, it is necessary to decompress the stomach and proximal duodenum using a nasogastric tube or gastrostomy tube; decompression is created until the diameter of the proximal duodenum decreases and normal peristaltic activity is achieved. Feeding begins, gradually increasing the volume.

Atresia (fusion, obliteration) of the intestine is a congenital pathology of the development of gastrointestinal tract. intestinal tract child, consisting in the absence of a lumen in one of its areas.

Depending on the location of the pathology, several types of atresia are distinguished:

• pyloric – located directly after the stomach;
• duodenal atresia - located at the very beginning small intestine;
• jejunal atresia - the area is located between the upper and bottom small intestine;
• ileal atresia;
• colonic atresia - diagnosed in the area of ​​the rectum and anus.

Duodenal atresia

Duodenal atresia develops in the second or third gestational month. The pathology is characterized by complete closure of the lumen of the intestinal tube. In this case, a significant expansion of its proximal end occurs, capable of reaching the size of the stomach in its volume. In this case, the distally located intestinal loops have a small diameter and are welded together.

Atresia may indicate following signs:

• regurgitation of amniotic fluid;
• after feeding, the child develops vomiting with bile impurities. This is explained by the fact that the intestinal fusion is located below the papilla of Vater;
• The abdomen is painless and soft on palpation, visually retracted;
• with obliteration of the duodenum, the passage of original feces is observed, but then the stool stops completely;
• in the first two days after birth the baby remains calm – general state child is normal. Later, he develops signs of toxicosis and exhaustion: the fat layer disappears, facial features become sharper, the skin becomes dry;
• aspiration pneumonia develops.

If left untreated, the child dies within 1.5 weeks from exhaustion and progressive pneumonia.

Diagnosis and treatment

To clarify the preliminary diagnosis, radiography is used. The image will clearly show gas bubbles located in the stomach and duodenum. In this case, the intestinal loops remain free. To obtain a more accurate image, a contrast technique is used.

On x-ray the absence of a section of the duodenum is quite clearly visible

Additionally carried out differential diagnosis with other congenital anomalies, in particular, annular pancreas. Treatment of pathology involves immediate surgical intervention. Its type depends on the location of the atresia relative to the papilla of Vater.

If the gastrointestinal tract is obliterated, a duodenojejunostomy is performed; if the obliteration is located higher, a gastrojejunostomy is performed. After the operation, the child may experience signs of duodenal dysfunction for quite a long time - regurgitation and vomiting.

Pathology of the small intestine

Atresia thin section intestines in newborns is most often diagnosed in lower section ileum. Slightly less common in the upper gastrointestinal tract. In some cases, the cause of obstruction of the intestinal tube is the presence of a membranous septum.

With atresia small intestine the newborn develops a fairly characteristic clinical picture:

• the child develops uncontrollable vomiting with admixtures of blood and bile, and later admixtures of feces appear;
• no passage of meconium is observed;
• after feeding, intestinal motility increases significantly, clearly visible through the abdominal wall;
• bloating occurs against the background of a decrease in urine output, up to the complete cessation of its passage;
• vomiting causes the development of toxicosis and rapid weight loss, despite a good appetite.

Symptoms of small intestinal atresia appear on the first day of a baby’s life

Sharp retraction abdominal wall indicates an intestinal rupture has occurred. The newborn's condition deteriorates sharply, skin acquire characteristic gray-green color.

The main method for diagnosing pathology is X-ray examination. If, in addition to the characteristic gas bubble, several more bubbles with a level are distinguished, then the location of the atresia is upper sections Gastrointestinal tract.

Numerous air bubbles with fluid levels become a sign of atresia, localized in the lower ileum or the very beginning of the large intestine. During radiology, the use of barium porridge orally is strictly prohibited.

The drug causes significant distension of the intestines, increasing the risk of perforation, and also increases the urge to vomit.

The disease has poor prognosis, but in full-term children with early surgery and a small number of atresias, it improves. Surgery is recommended immediately after identifying pathology.

Rectal atresia

Rectal atresia is a congenital pathology characterized by underdevelopment anus(anus). Most often, the anomaly is diagnosed in boys. The disease requires emergency surgical correction performed within the first 24 hours after birth.

The pathology develops in the early antenatal period (from 12 to 29 gestational weeks) and is caused by fetal developmental disorders. The condition is characterized by the absence of an opening at the proctodeum (the depression at the posterior end of the fetal body that then becomes the anus) and the failure of the cloaca to separate.

Classification

Rectal atresia is usually divided into:

• to high (supralevator);
• average;
• low (sublevator).

The second classification of pathology divides rectal atresia into total (complete closure of the lumen of the intestinal tube occurs, without a fistula), occurring only in 10% of all diagnosed cases, and fistula format, which occurs in the remaining 90%.

The fistulous form of rectal atresia occurs following types:

• the pathological channel is discharged into the organs of the urinary system;
• fistulas come out into reproductive system;
• directly into the perineum.

Symptoms

First Clinical signs pathologies form 12 hours after the birth of a child - he becomes restless, sleeps poorly, refuses to latch on to the breast and almost constantly pushes. By the end of the first day of life, symptoms of intestinal obstruction appear: absence of meconium; the child begins to swell - observed severe bloating belly.

Vomiting begins, which contains bile and feces, and signs of intoxication and dehydration appear. If the baby does not receive qualified training in the near future medical care, he will die from intestinal perforation and subsequent peritonitis.

With low rectal atresia, instead of the anus, the child has a small funnel-shaped depression. Sometimes it is completely absent.

In some cases, the anomaly manifests itself as an overgrowth of the intestine, and then the anus is simply blocked by a film through which the accumulated meconium is clearly visible. A sign of this form of pathology is bulging of the anus during tension, the so-called “push” syndrome. With high supralevator atresia, it is absent.

After birth, all children, without exception, are tested for congenital anomalies. The anal area is also subject to mandatory inspection. In case of pathology, instead of the anus, the child will have a small depression.

It is important for doctors to determine the severity of the pathology. If the baby is missing only the anus, and the intestine itself is fully developed, then when the child cries, a protrusion is observed in the area of ​​the anus.

Fistulas extending into the urinary system are diagnosed in most cases in male infants. For girls this variety atresia is much less common. A sign of pathology is the presence of meconium particles in the urine, and when straining, urethra gases come out.

Entry of intestinal contents into urinary tract causes the development of cystitis, pyelonephritis, and urosepsis.

A sign of a fistula of the colon, which has an outlet into the vagina, is the release of original feces through the genital opening. Acute intestinal obstruction with this format, atresia does not develop, but the release of feces in a similar way leads to the formation of vulvitis and various inflammations urinary system.

Another option for opening a fistula is the perineal area. Most often, an abnormal canal forms near the anus, scrotum, or at the base of the penis. Commitment normal act defecation is also impossible, so the baby will develop symptoms of intestinal obstruction in the next few hours.

Diagnosis and treatment

To diagnose atresia, an X-ray examination is prescribed to the infant. In some cases, palpating the rectum is sufficient, during which the doctor encounters an obstacle.

Treatment of rectal atresia is only possible surgically. Children with sublevator (low) rectal atresia undergo perineal plastic surgery. At average and high form pathologies in progress surgical intervention an end colostomy is formed (extraction of part of the colon or sigmoid colon to left side abdomen) with subsequent correction.

An infant operated on for intestinal atresia with a removed colostomy

After surgical treatment With moderate and high atresia, children often develop fecal incontinence. The prognosis in the absence of adequate therapy is unfavorable: the death of the child occurs on the fifth or sixth day after birth. But a timely operation is not a guarantee. full recovery. The intestines begin to function fully only in 30% of operated infants.

Colon atresia

Colonic atresia is characterized by complete obstruction of this section of the intestine. The pathology is extremely rare and accounts for only 2% of all diagnosed cases of intestinal atresia. The cause of the formation of the anomaly is considered to be intrauterine necrotization of a section of the colon as a result of pathological conditions, in particular, volvulus.

Signs of colon atresia appear in an infant on the second or third day. This is indomitable vomiting containing meconium impurities, bloating. At visual inspection you can notice stretched loops of intestine protruding through the abdominal wall.

Diagnosis includes mandatory radiography. The image clearly shows numerous gas bubbles with horizontal liquid levels. The intestinal loops are stretched, and the non-functioning section of the intestine itself looks like a thin cord.

An atretic area can be diagnosed in any part of the colon

Treatment of the pathology is surgical and consists of removing the atretic portion of the intestine, followed by the application of a colonic anastomy. In case of intestinal rupture and peritonitis, a proximal colostomy may be installed.

Intestinal atresia is one of the most complex anomalies in the formation of the intestinal tract. After diagnosing the pathology, the baby needs emergency surgery. Otherwise, the disease has an extremely unfavorable prognosis.

The invention relates to medicine, namely surgery, and can be used in the treatment of duodenal atresia in children. The essence of the invention: in the transverse mesentery colon a window is formed, the edges of which are sutured to the anterior wall of the duodenum. A loop of jejunum is brought to the duodenum. A duodenojejunostomy with a length of 1.5-2 cm is formed at a distance of about 5 cm from the Treitz ligament. One row of single 5/0 prolene sutures is placed on the anterior and posterior lips of the anastomosis on an atraumatic needle with knots into the intestinal lumen. Then, at a distance of 1-1.5 cm from the formed duodenojejunostomy, the adductor colon is fixed to the lower surface of the mesentery of the transverse colon, closer to its root, with 3-4 seromuscular sutures spaced at an equal distance from each other. The proposed method has the following advantage: fixation of the afferent colon of the duodenojejunostomy to the mesentery of the transverse colon prevents sagging and impaired emptying of the adductor colon, which lengthens as the child grows. 2 ill.

The invention relates to medicine, namely to surgery, and can be used in the treatment of duodenal atresia in children. The disease is a congenital malformation and manifests itself as high intestinal obstruction during the neonatal period. Lack of surgical care leads to the death of the newborn. Lethality when used modern methods treatment reaches 30-40% There is a known method of treating duodenal atresia in children, which consists in connecting the lumens of the duodenal sections above and below the atresia zone (G. A. Bairov, Yu. L. Doroshevsky, T. K. Nemilov Atlas of operations in newborns, L. 1984, pp. 55-58). The disadvantage of this method is that it is only feasible in cases where the diastasis between the segments of the duodenum is insignificant and allows them to be connected without strong tension. In cases where there is significant diastasis between the segments, agenesis of the distal part of the duodenum, as well as with multiple lesions of the duodenum, the application of duodenoduodenoanastomosis causes significant difficulties. The prototype of the invention is a method for treating duodenal atresia in children, which consists in bringing the initial section of the jejunum behind the transverse colon through a window in its mesentery to the anterior wall of the dilated duodenum and forming a duodenojejunostomy with a single-row interrupted suture. Due to the application of duodenojejunostomy to the initial part of the jejunum, the afferent loop of the anastomosis is short, does not sag, and when food masses are thrown into it, it empties satisfactorily. Disadvantage this method is that it does not take into account changes in topographic-anatomical relationships during the growth of the child, namely the lengthening of the intestine, in particular, the adductor duodenojejunostomosis. As a result, the adductor colon begins to sag and the evacuation of food masses entering it becomes difficult. This can lead to expansion of the adductor colon and the development of the “cecum” syndrome (Fig. 1). The purpose of the invention is to prevent postoperative complications and ensuring adequate function of the created duodenojejunostomy. The goal is achieved by fixing the loop of the afferent colon of the anastomosis to the mesentery of the transverse colon. This prevents sagging and impaired emptying of the adductor colon, which lengthens as the child grows. The implementation of the method is illustrated in Fig. 2, which shows a diagram of the formed duodenojejunostomy. The method is carried out as follows. A laparotomy is performed with a longitudinal incision through the right rectus abdominis muscle. After examining the blindly ending segment of the duodenum, which is usually represented by a large sac with thickened walls, the transverse colon (1) is tilted upward. In the mesentery (2) of the transverse colon, an avascular zone is selected. Within the boundaries of this space, a window is formed, the edges of which are sutured to the anterior wall of the duodenum (3), limiting the area for the future anastomosis. A loop of jejunum is brought to the duodenum. Duodenojejunostomy is formed at a distance of about 5 cm from the ligament of Treitz (4). To do this, the lumen of the duodenum and jejunum is opened for 1.5-2 cm. One row of single 5/0 prolene sutures is placed on the anterior and posterior lips of the anastomosis on an atraumatic needle with knots into the intestinal lumen. Then, departing from the formed duodenojejunostomy (5) about 1.5 cm, the adductor colon (6) is fixed to the lower surface of the mesentery (2) of the transverse colon, closer to its root, with 3-4 serous-muscular sutures spaced from each other friend at an equal distance. After this, the anterior abdominal wall is sutured tightly. The proposed method was tested in the Rostov Pediatric Surgery Clinic medical institute in 4 patients. Example. Patient S., medical history N 9644/710, was admitted to the pediatric surgery clinic on May 14, 1994 with a diagnosis of high intestinal obstruction. Atresia of the duodenum. After preoperative preparation A right transrectal laparotomy was performed under endotracheal anesthesia. When examining the abdominal organs, it was discovered that the stomach was enlarged in size, the duodenum, including the upper horizontal and descending parts, as well as the initial section of the lower horizontal part, was expanded to 2.5 cm in diameter. An area of ​​atresia up to 0.5 cm in length is localized in the distal part of the duodenum. Small intestine up to 0.6 cm in diameter, collapsed. The patient underwent duodenojejunostomy with the entry of the initial section of the jejunum behind the transverse colon through a window in its mesentery. An anastomosis 2 cm long was formed with a single-row interrupted suture into the intestinal lumen (Prolene 5/0). At a distance of 1 cm from the anastomosis, the adductor colon is sutured with 4 seromuscular sutures to the lower surface of the mesentery of the transverse colon near its root. Postoperative period proceeded without complications. The laparotomy wound healed by primary intention. Within 8 days after the operation, the child had up to 40-50 ml of congestive gastric discharge per day through the nasogastric tube. Then the amount of discharge from the stomach decreased to 25 ml and became lighter, and therefore the probe was removed. On the 6th day, scanty stool was noted after the enema. On the 10th day, the child began to feed 5 ml every 3 hours. There was no vomiting or regurgitation. On the 15th day the child received 30 ml of expressed breast milk and was transferred to the neonatal pathology department. Where he was discharged on the 30th day after surgery with a weight of 3200 g. Compared with the prototype, the proposed method has the following advantage: fixation of the adductor colon of the duodenojejunostomy to the mesentery of the transverse colon prevents sagging and impaired emptying of the adductor colon, which lengthens as the child grows.

Claim

A method for the treatment of duodenal atresia in children, involving the imposition of a duodenojejunostomy with the introduction of the initial section of the jejunum behind the transverse colon through a window in its mesentery, characterized in that the adductor colon of the duodenojejunostomy is fixed with 3 to 4 seromuscular sutures spaced at an equal distance from each other, to the lower surface of the mesentery of the transverse colon.

Atresia is congenital anomaly, manifested by the absence or overgrowth of any natural opening or canal in the human body, rarely resulting from other present diseases.

The following types of this pathology are most often recognized:

Rectal atresia

Anal atresia

Atresia of the hymen

Esophageal atresia

Duodenal atresia

Hymenal atresia

Atresia joan

Venous atresia

Atresia of the external auditory canal

Lacrimal punctal atresia

Atresia of the internal os

Atresia cervical canal and etc.

Congenital atresia

Doctors have been involved since the birth of the child congenital pathologies. They are found during examination of a newborn. The features of such anomalies are easier to group from a simple visible form to a complex, sometimes even unique one.

In children, such pathologies most often are not observed in the first hours of their life, unless they are too obvious. But the most common atresia in a newborn, anal atresia, makes itself felt within a few hours. There is a lack of meconium waste, and sometimes even with a superficial examination it is possible to determine the absence of the anus. Since the concept of high and low atresia has not yet been accurately classified when defining them in the intestinal region relative to their location in relation to the levator muscles (above or below), it is believed that the high one is deeper than 2.5 centimeters, therefore, the low one is up to this value . In newborns with this pathology, discomfort is noted, the tummy swells, and vomiting begins: first with the contents of the stomach, and a little later - with an admixture of bile. The child no longer wants to feed, toxicosis progresses, and vomiting becomes more frequent. If the child is not helped surgically, this type of disease very quickly passes into the acute stage - intestinal perforation and peritonitis. Such atresia carries dire consequences– up to and including deaths.

There are no 100% established causes of intrauterine anomalies in children. The causes of atresia are most often congenital.

photo of esophageal atresia

Esophageal atresia

Such an anomaly is a serious defect. With it, part of the upper segment of the esophagus ends indistinctly, and part of the lower segment may fall into the trachea. This deviation in children is often combined with defects of the following organs:

- heart;

— gastrointestinal tract;

- genitourinary system.

Most often, such defects occur when there is chromosomal disease. Esophageal atresia in children is associated with defects in early stage embryogenesis. At an early stage, the trachea is connected to the esophagus and they separate only after a month. If this does not happen, then there is a risk of miscarriage. If an unauthorized miscarriage does not occur, the child is born with a defect, which is called esophageal atresia. The consequences of such a disease can be fatal if this problem is not surgically solved.

Causes of fetal esophageal atresia :

- dependence on alcohol consumption;

- smoking addiction;

- drug addiction;

- X-ray examination during the first trimester of pregnancy;

Uterine atresia occurs exclusively in women. From a medical point of view, it represents overgrowth and obstruction. During menstruation, this anomaly is accompanied by pain. At gynecological examination the doctor can additionally identify the development of hematosalpinx, in more severe case- And . Treatment is exclusively surgical.

At the entrance of the cervix there is a space called the cervical canal. It stretches, but only in reproductive age. During the opening from the vagina to the sterile uterus, it decreases in both length and width. This change is caused hormonal disorder, which is inevitable during menopause (a natural process), and is called atresia of the cervical canal in postmenopause.

Symptoms different types atresia

Symptoms of atresia of the esophagus, colon and small intestine depend on the degree and type of intestinal damage. The more advanced the disease, the more pronounced the symptoms.

Intestinal obstruction is a severe pathology. By some symptoms you can identify the disease and begin timely treatment. The main signs of atresia in newborns:

- Spasmodic pain;

- Bloating;

— Absence of defecation;

- Foamy discharge from the mouth;

- Strong salivation;

- Vomiting during feeding;

- Cough;

- Moodiness, anxiety;

- Difficulty breathing;

- Refusal of milk.

The pain with atresia is sharp, growing in the navel area. With partial obstruction or fistulas, it can be observed. With bloating, asymmetry of the abdomen is characteristic, the child is restless and constantly tightens his legs. When feeding, choking, coughing and vomiting begins. The vomit contains an admixture of bile; in advanced cases, fecal discharge appears. With obstructive and adhesive forms, vomiting becomes continuous. Such symptoms are often complicated.

With obstruction of the large intestine, the symptoms are less pronounced than with pathologies of the small intestine. If the obstruction of the small intestine is partial, doctors may prescribe conservative methods treatment for complete obstruction surgical intervention Necessarily.

Symptoms of atresia can be classified according to the location of the pathology:

Anus. The posterior opening is closed completely or partially. There is a depression no larger than 5 mm in size, the child cannot defecate. The rectum may fuse with bladder. In this case, the urine becomes dark and unusual in color.

Microtia. Partial or complete fusion ear canal. The child becomes deaf or has no hearing at all.

Biliary atresia. A newborn develops jaundice. The bile ducts are either completely absent or partially obstructed. The skin tone becomes greenish-yellow, bilirubin increases, and the thrombus index decreases. Urine acquires dark shade, the liver enlarges.

Esophagus. Exudes from the child's mouth and nose white foam, copious flow of saliva. Often occur with atresia of the esophagus, heart defects and gastrointestinal tract.

Small intestine. The newborn is missing a significant part of the intestine. The parts of the intestine are connected by a cord. The child vomits during feeding. Bile and feces may be released from the mouth.

Follicular atresia. Sometimes it develops unnoticed and leads to infertility.

Pulmonary artery. At birth, the child acquires a bluish tint that does not disappear. Frequent shortness of breath, suffocation when feeding.

Vagina. Vaginal fusion, frequent spasmodic pain in the lower abdomen,. Inability to be sexually active.

Choanal atresia. Posterior region the nose is narrowed, the passage is covered with fabric. Breathing problems appear. The child needs to be provided urgent help at birth, since newborns cannot breathe through their mouths.

Tricuspid valve. The blood circulation process in the heart is disrupted. Develops, there may be loss of consciousness, shortness of breath. This leads to blockage of blood vessels.

With atresia with fistulas, the child defecates in small quantities. If the fistula is wide, then feces come out as usual and pathology may not be immediately suspected. Partial obstruction develops with variable pain and bloating.

Diagnostics

Many people or parents wonder: how is atresia diagnosed? various forms specialized doctor?

Making a diagnosis of obstruction of the anus and esophagus is not difficult. Even in the maternity hospital, newborns are immediately carefully examined. If the first stool, meconium, is not excreted, then the doctor immediately diagnoses it as atresia. When examining the anus, the skin may be too thin, which indicates the form of the disease. In the presence of biliary atresia, the doctor pays attention to the symptoms: the presence of a yellow tint to the skin. A pregnant woman may be diagnosed with an ultrasound scan. If the stomach of the fetus is not visible on ultrasound, doctors make a diagnosis of atresia in advance.

Diagnosis of esophageal atresia can be carried out using:

Purposes of abdominal fluoroscopy. Viewing chest. Fluoroscopy is divided into non-contrast and contrast. In the first option: the inserted catheter is visible in the blind segment of the esophagus. If there is a fistula, then the stomach and intestines are filled with air. With contrast fluoroscopy, the blind end of the esophagus is clearly visible;

Using a catheter. Entered via nasal cavity. If the catheter rests against the wall of the esophagus without further advancement or enters the trachea, this means the presence of pathology;

An “Elephant test” is performed. Air is introduced through a probe into the blind end of the esophagus, which exits through the nose. Probing of the esophagus is quick, but the method is not 100% accurate.

After the birth of a newborn, gases accumulate in the intestines within a couple of hours. During fluoroscopy, the child is turned upside down. The resulting gas bubble allows you to examine the position of the intestine and establish an accurate diagnosis. This is necessary to know for a quality operation. If complete atresia is not detected in time, the newborn does not survive even a week.

Esophageal atresia can be diagnosed if the patient already has established diseases:

- Atresia of the anus;

- Heart disease;

- Prematurity;

— Pathologies upper limbs;

— Pathologies of the spine;

- Polyhydramnios in a pregnant woman.

When diagnosing intestinal obstruction, the doctor pays attention to following symptoms:

- Mathieu-Sklyarova. It is carried out by palpation. When the abdominal wall is shaken, a splash of fluid that has accumulated in the intestine is heard.

- Shimana-Danza. It is carried out by palpation. The right iliac fossa appears empty.

- Chugaeva. If you pull the child's legs towards the stomach, a noticeable transverse stripe appears on the stomach.

- Hose. When palpating the abdomen, increased bloating and gas formation are noticeable.

- Krivulya. When palpating the abdomen, a metallic sound is heard.

- Obukhovskaya. The rectum and anus are dilated.

- Golda. Determined by palpation. The loops of the small intestine are distended.

— Tsege-Manteuffel. When introducing water into the rectum, more than half a liter cannot be introduced.

If intestinal obstruction is suspected, the doctor checks the hernial orifice for the moment of pinching. An x-ray of the abdominal cavity is taken. If dynamic intestinal obstruction is detected, then it is imperative to immediately identify the cause; it may be the presence of: appendicitis, pancreatitis, blood clots and other pathologies.

Atresia of the colon and small intestine is detected through an abdominal x-ray. If the presence of a number of distended loops of the small or large intestine is detected, the diagnosis is confirmed. The x-ray shows volumetric formations due to the accumulation of gases.

The doctor may prescribe additional examination:

— Echocardiography of the heart;

— Screening using amniocentesis;

— X-ray of the kidneys;

— Test for sweat chloride concentration.

Treatment of different types of atresia

Treatment of esophageal atresia

Treatment for esophageal atresia should begin immediately after detection, because with this defect the esophagus ends after 10 cm, and the child cannot eat. In this case, after birth, the child secretes saliva profusely (through the nose and mouth), and it foams heavily. The baby's belly is noticeably enlarged.

Treatment for esophageal atresia begins with inserting a catheter into the esophagus to drain mucus from the oropharynx. This is followed by the prescription of broad-spectrum antibiotics and hemostatic drugs.

With atresia thoracic esophagus after necessary research doctors are often faced with the obvious need to immediately perform an operation (if the child weighs more than two kilograms, and it is vital important systems body is normal).

Surgical treatment of esophageal atresia is accompanied by gastric emptying using a fistula. In this case, the child should lie on his stomach with his head fixed at 40 degrees.

Postoperative care. Prevention

Clearly, in case of esophageal atresia, further follow-up will be required after surgery. medical care. The recovery method depends on wide range factors. The severity of abnormalities in the lungs, the age of the child and other anomalies that have arisen are taken into account. The postoperative period for esophageal atresia can pass without anomalies, which will allow extubation. If the lungs cannot independently carry out gas exchange, then after surgery the use of ventilation support for the lungs will be required. It is forbidden to straighten your neck for several days (up to about a week). Often, due to neck movements, the seams can break their integrity. Prescription of painkillers is mandatory.

Esophageal atresia after surgery requires strong opioid analgesics. If there are no complications, the drainage that was left during the operation is removed after a week. Also, in the postoperative period, the patient needs infusion therapy, for which glucose is used in a 5-10 percent solution. Later, you can start feeding the child parenterally.

At proper care In the case of a child, esophageal atresia will not progress and cause complications; the postoperative period, spent under the guidance of doctors, will allow one to achieve the best possible prognosis for recovery.

Treatment of anal atresia

To begin treatment for atresia, it is also necessary timely diagnosis. It is dangerous to delay surgery when a child has anal atresia; surgery is needed immediately. Due to the absence of the anus, fistulas open, which can cause additional pathologies, so treatment of this pathology should begin as early as possible.

Treatment of anal atresia takes place in several stages. The operation begins with the colostomy removing stool. Next, the anus is formed and then the integrity of the intestine is restored. The course of the operation depends on the type and height of atresia. If atresia of the anus arose due to the covering of the rectum with a film, then the most simple operation(you may not even need to apply stitches, since only a cross-shaped incision is made in the closed anus). If there is a fistula in the anus and surgery is required to eliminate anal atresia, then Stone-Benson proctoplasty is used. If the pathology is accompanied by a fistula to the perineum, the operation may be limited to widening the fistula opening. When anal atresia is noted in combination with long perineal fistulas, Salomon's operation is performed: the most optimal in such a situation. For any other low form of anal atresia, surgery can be performed using a combined paracrcigeal-perineal approach.

Treatment of rectal atresia

Treatment of this type of atresia occurs only operative method. Surgery to treat rectal atresia begins with pain relief. If the anomaly simple type, then the operation is performed using proctoplasty. If the atresia is high, then the operation of rectal atresia is performed using the method of abdominoperineal proctoplasty. Such a surgical intervention includes several stages, and after it a course of physical therapy is mandatory.

If the child is premature and weighs less than two kilograms, then surgery to treat rectal atresia is performed through palliative intervention, i.e. an unnatural anus is created. When the fistula has a connection with urinary system, the operation is prescribed already in the first hours of the child’s life, because there is a high risk of spreading the infection. When a girl's fistula is directed to the reproductive system, surgical intervention can be postponed until the age of 3-4 years, because at this moment it is easier to implement technically than in a newborn. If a newborn has developmental complications due to an anomaly, then surgery to treat rectal atresia is performed six months after birth.

If stenosis is detected, no operation is performed, but only a bougie is inserted, which is gradually expanded. If with this treatment there is no improvement after 3-4 months, then you have to resort to surgery.

Fistulas that do not affect the functioning of the anus are removed promptly, and surgery directly on the rectum is not necessary.

Contraindications for surgery. The result of treatment.

The results of treatment after the operation have been performed can be seen very quickly. The postoperative period is usually uneventful, and rehabilitation is most often successful.

Pulmonary atresia is very dangerous for the life of a child. Even after surgery for atresia pulmonary artery 51% of newborns die. Because only good specialist will be able to save the baby’s life through the operation. Therapeutic treatment V similar situations turns out to be powerless.

There are several types of operations performed for pulmonary atresia, and suitable method treatment can be selected after ultrasound diagnostics. The essence of treatment and surgery is always the same - to allow free movement of blood from the ventricle of the heart and restore blood flow to the lungs. After surgery, it is mandatory to take a course of medications that will prevent the closure of the arterial ducts.

The need for surgery for biliary atresia is clear. Children with such an anomaly do not live up to three years. Before starting treatment with surgery, for atresia of this localization, it is necessary to do a liver biopsy. Most optimal age for surgery for biliary atresia it will be 40-60 days; if the operation is performed later, then the prognosis for recovery is not optimistic. All operations for biliary atresia are aimed at restoring the function of bile excretion. Enough long period rehabilitation after surgery and additional treatment can increase the child's chances of recovery.