The child was born with repeated vomiting, abdominal distension, and no meconium discharge, and was diagnosed with this digestive tract malformation disease

It is only for medical professionals to read and reference.
Once diagnosed with congenital intestinal atresia, the neonatologist should promptly consult a pediatric surgeon and perform surgical treatment as soon as possible
.

Congenital intestinal atresia (congenital intestinal atresia): uncommon in neonatal digestive tract malformations, is one of the most common causes of neonatal intestinal obstruction, often accompanied by other malformations, such as congenital anal atresia, congenital esophageal atresia , congenital heart disease, hypospadias,
etc.

Case overview A child, female, 1 day old, was admitted to the hospital due to "vomiting and abdominal distension for 1 day"
.

History of present illness: the mother of the child had 2 births 2, the gestational age was 35 weeks + 1 day, and was born by cesarean section in a foreign hospital due to "fetal distress".
The birth weight was 2.
5 kg, and the amniotic fluid was second-degree fecal staining.
The volume was large, about 2500 ml, There was no abnormality in the umbilical cord, the placenta and fetal membranes were delivered completely, and after being warmed after birth, the respiratory tract was cleaned, and the Apgar score was 9 points in 1 minute, 10 points in 5 minutes, and 10 points in 10 minutes
.

After birth, she was fed with formula milk, and she vomited shortly after feeding.
The vomit was stomach contents, containing bile, without coffee-like substance, and accompanied by abdominal distension.
For further diagnosis and treatment, the family members went to our hospital for further treatment, and she was admitted to the NICU for further treatment
.

Since birth, the child has no shortness of breath, no cyanosis, no fever, no special urination, and no meconium
.

Family history: The mother of the child had regular obstetric examinations in other hospitals
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Color Doppler ultrasound at 28 weeks of gestation showed fetal bowel dilatation; color Doppler ultrasound at 33 weeks of gestation showed that fetal gastric vesicles were enlarged and the bowel tube was dilated, and the possibility of gastrointestinal obstruction was considered
.

Physical examination: normal response, weak crying
.

There were no rashes and bleeding spots on the whole body
.

Anterior fontanelle is soft
.

The pupils on both sides are equal in size, with a diameter of about 2.
5mm, and are sensitive to light reflection
.

No cyanosis of lips, abdominal distension, slightly high abdominal wall tension, no exposure of abdominal wall veins, visible intestinal type, no abdominal mass, liver and spleen under the ribs, and bowel sounds about 4 to 5 times per minute
.

Cardiopulmonary examination showed no abnormality
.

Admission diagnosis: 1.
Digestive tract malformation? 2.
Premature babies
.

The examination made the cause gradually clear.
Figure 1 After birth, the child had vomiting, abdominal distension, no meconium discharge, and polyhydramnios.
Combined with the color Doppler ultrasound during pregnancy, the fetal bowel was dilated.
Considering the possibility of digestive tract malformation, the patient was admitted to the hospital to complete the abdominal upright plain film examination.
(Fig.
1), the result showed the three-bubble sign (the left subdiaphragmatic air sac suggests gastric vesicle, and the other air sacs are the dilated duodenum and proximal small intestine)
.

Then complete the gastrointestinal angiography
.

Angiographic examination of the upper gastrointestinal tract showed that the stomach was full and full, and the upper segment of the duodenum and jejunum were dilated (see Figure 2).
See Clear Contrast Entry into the Small Intestine
.

(See Fig.
3) Fig.
2 and Fig.
3 diagnostic prompts: complete small bowel obstruction and fetal colon, consider the possibility of small bowel atresia with intestinal malrotation
.

Combined with the results of abdominal upright plain film and gastrointestinal angiography, intestinal atresia was initially considered
.

After consultation with a pediatric surgeon, he was sent to the operating room for exploratory laparotomy.
During the operation, it was found that there were two blind ends of the jejunum atresia, mesenteric defects at the blind ends of both sides, the small intestine at the proximal end of the atresia and the duodenum were significantly dilated, and the atresia distal The distal small intestine is generally developed, and the entire colon is uniformly fetal
.

In the end, the diagnosis of jejunal atresia (type IIIb) was definite, and end-to-side anastomosis and ostomy of the distal small intestine and the proximal small intestine were performed, and postoperative gastrointestinal decompression and intravenous nutritional support were performed
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What are the clinical features of children with congenital bowel atresia? Intestinal atresia can occur in any part of the bowel, with the ileum being the most common, the duodenum being the second, the jejunum being less common, and the colon being less common
.

It can be divided into 4 pathological types: type I (membranous atresia), type II (blind end atresia, two broken ends are connected by fiber cords), type IIIa (blind end atresia, two broken ends separated), type IIIb (apple Dermoid atresia), type IV (multiple atresia)
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Since intestinal atresia is a complete intestinal obstruction, the main symptoms are "vomiting, distending, and closing", that is, vomiting, abdominal distension, and no meconium discharge
.

1.
Vomiting: The higher the atresia site, the earlier and more frequent vomiting occurs
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High intestinal atresia (duodenal atresia) occurs during the first breastfeeding after birth, and the vomit is gastric and duodenal secretions, containing bile
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Low intestinal atresia (jejunal, ileal, and colonic atresia) often vomits at the end of the first day or on the second day, with a large amount of vomiting, and the vomitus is fecal-like and smelly
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The frequency and degree of vomiting increased progressively
.

2.
Abdominal distension: The abdominal distention of high intestinal atresia is confined to the upper abdomen, the lower abdomen is relatively sunken, and gastric peristalsis waves from left to right can be seen, no tumor can be touched, and the abdominal distension is relieved after vomiting
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Low intestinal atresia shows full abdominal distension after birth, and the abdominal distension does not decrease after vomiting.
The intestinal pattern can be seen, the bowel sounds are hyperactive, the percussion is tympanic, and the liver dullness level rises
.

Abdominal varicose veins can be seen if abdominal distension is aggravated with intestinal perforation
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3.
No meconium excretion: There is usually no normal meconium excretion after birth, only a small amount of gray-white or blue-gray jelly-like stool is excreted, which is composed of intestinal mucosal secretions and exfoliated cells.

.

In a small number of children, meconium has been formed in the late pregnancy, and intestinal atresia caused by blood flow disorder can excrete a small amount of green meconium, which will be excreted without migration later
.

4.
General situation: The symptoms are generally good in the early stage, but in the late stage, due to frequent vomiting, weight loss, dehydration and electrolyte imbalance soon appear, often secondary to aspiration pneumonia
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Auxiliary examination to help diagnose 1, abdominal X-ray: for the diagnosis of great value
.

High intestinal atresia standing X-ray shows 2 to 3 enlarged fluid levels in the upper abdomen, which is called the double-bubble or triple-bubble sign (the double-bubble is formed by the fluid level in the first segment of the stomach and duodenum.
In the distal end of the duodenum, there are 3 liquid levels), and the other intestinal segments are not inflated
.

In low intestinal atresia, multiple enlarged intestinal segments and fluid levels can be seen, and the remaining intestinal segments and colon are not inflated
.

With intestinal perforation, free gas can be seen under the diaphragm
.

2.
Prenatal ultrasound examination: Ultrasound examination of pregnant women with polyhydramnios is valuable for the diagnosis of fetal intestinal atresia
.

Fetal intestinal atresia usually has abnormal ultrasound signs after 24 weeks of gestation, and multiple fluid-filled bowel echoes can be seen in the fetal abdominal cavity, while in the fetus with duodenal atresia, a dilated stomach and duodenum appear as "double vacuoles" in the upper abdomen.
sign"
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The higher the position of intestinal atresia, the more obvious polyhydramnios, and the degree of intestinal dilatation increases with the increase of gestational age
.

3.
MRI examination: In recent years, it has been gradually applied to clinical diagnosis of fetal congenital intestinal atresia, which has improved the accuracy of prenatal diagnosis
.

Note that children with these diseases have persistent vomiting after birth, no normal meconium discharge within 24 to 36 hours, and progressive abdominal distension, and intestinal atresia should be considered
.

It is more likely if the mother has a history of polyhydramnios or other malformations at the same time
.

Can do digital rectal examination first, or enema with warm saline or 1% hydrogen peroxide solution, there is still no normal meconium discharge, which can rule out meconium constipation and megacolon
.

Congenital intestinal atresia also needs to be differentiated from the following diseases: 1.
Congenital intestinal malrotation: due to incomplete intestinal obstruction at the onset, mild symptoms, late vomiting, and gradual aggravation of symptoms, barium enema can be identified
.

2.
Meconium intestinal obstruction: due to abnormal secretion of mucous glands in the body, thick mucus, and the accumulation of intestinal contents in the distal ileum, blocking the intestinal lumen, mostly manifested as low intestinal obstruction symptoms
.

Vomiting after birth, the vomit is dark green, the abdominal distension is obvious, and a small amount of meconium can still be excreted.
The keratinized epithelium can be seen in the meconium, and the abdominal X-ray can see granular shadows
.

3.
Hypertrophic pyloric stenosis: In some cases, intestinal atresia is located in the upper segment of the duodenal ampulla, and the vomitus does not contain bile, which needs to be differentiated from hypertrophic pyloric stenosis
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Early treatment can improve the prognosis of children.
Early detection, early diagnosis, and early treatment can improve the cure rate.
Otherwise, most children die within a week due to secondary intestinal perforation, peritonitis, intestinal necrosis, and aspiration pneumonia
.

Treatment 1, the general treatment: Once diagnosed, fasted immediate decompression, intravenous nutrition infusion caloric feed to ensure correct water and electrolyte imbalance, correction of acidosis, vitamin K and C, prophylactic antibiotics and the like
.

2.
Surgery: Surgery is the only effective treatment
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The morning and evening of surgical treatment, preoperative preparation and postoperative care directly affect its prognosis
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The prognostic effect of surgery is related to the atresia location and pathological type.
Postoperative short bowel syndrome, functional intestinal obstruction and anastomotic leakage are also important factors affecting the treatment and prognosis
.

According to the different types of intestinal atresia, the following surgical methods can be selected: (1) Intestinal resection and anastomosis: Resection of 10-20 cm at the proximal end of the atretic bowel, 2 cm at the distal end, and end-to-end anastomosis; (2) End-to-side anastomosis with fistula: excessive hypertrophy of the proximal bowel.
Dilated, small distal bowel, end-to-side anastomosis and distal ostomy (Bishop-Koop method) or end-to-side anastomosis and proximal ostomy (Santulli method) can be performed; For those who have undergone intestinal resection and anastomosis, the distal and proximal intestinal canal can be made fistula, and the distal intestinal canal can be expanded, and then the intestinal anastomosis can be performed at a scheduled time
.

3.
Postoperative treatment: adequate gastrointestinal decompression, supplementation of appropriate amount of fluid, blood transfusion or plasma, maintenance of water and electrolyte balance and energy needs
.

Postoperative fasting should receive intravenous nutritional support
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After 3 to 4 days after the operation, after the anus is exhausted, liquid food can be taken, and enteral nutrition solution can be given
.

In order to better provide you with interesting, useful and attitude content, the Pediatrics Channel of the Medical World welcomes you to complete the following survey with your fingers, in just five seconds! References: [1].
Shao Xiaomei, Ye Hongmao, Qiu Xiaoshan.
Practical Neonatology.
5th Edition [M].
Beijing: People's Health Publishing House, 2019: 653-654.
[2].
Hu Yamei, et al, Zhu Fu Tang Practical Pediatrics (8th Edition) [M].
People's Health Publishing House, 2015: 1423-1424.
[3].
Xia Renpeng, Zhou Chonggao, Wang Haiyang, et al.
Analysis of diagnosis and treatment of 147 cases of neonatal intestinal atresia [J] .
Zhonghua Journal of Neonatology, 2018, 33 (6): 442-445.
[4].
Lv Junjian, Peng Yanfen, Zhang Hong, et al.
Prognosis analysis of different surgical methods in the treatment of refractory congenital atresia of the small intestine [J] .
Chinese Journal of Neonatology ,2019,34 (3): 172-176.
[5].
Wang Guanghuan, Li Jianhong, Jiang Xuewu.
Diagnosis, treatment and prognosis of neonatal intestinal atresia[J].
Clinical Journal of Practical Pediatrics, 2009, 24(11):844-845 .