Intestinal atresia: histopathologist view
Keywords:Colon, Congenital anomaly, Ileum, Intestinal atresia, Inspissated bile, Jejunum
Background: Intestinal atresia forms one of a common cause for intestinal obstruction in neonates. There is a debate about its pathogenesis and many theories have been suggested. Studies regarding its clinical and histomorphological features are less in Indian literature. The present study aimed to determine the clinical and histomorphological features of cases of intestinal atresia.
Methods: Thirty-nine cases of intestinal atresia were studied both retrospectively (twenty-six) and prospectively (thirteen) over a period of two years. Their clinical and histomorphological features were studied.
Results: Intestinal obstruction was most common clinical diagnosis. Type II atresia was most common. Ileal atresia was highest in number. Associated congenital anomalies noted were situs inversus with splenunculi, patent vitelo-intestinal duct, duplication cyst, Meckel’s diverticulum, ileocecal web, duodenal web and omphalocele. Histological features such as inspissated meconium, calcification, ulceration, fibrosis, thick-walled vessels, edema were noted.
Conclusions: Findings such as mucosal edema, congestion, ulceration, submucosal edema, thick-walled blood vessels, fibrosis, hemorrhage, transmural ischemia, calcification, suggest that an intra vascular accident may be responsible for origin of the atresia.
Ratan SR, Rattan KN, Pandey RM, Sehgal T, Kumar A, Ratan J. Surgically treated gastrointestinal obstruction in children: causes and implications. Indian J Gastroenterol. 2006;25(6):320-2.
Adams SD, Stanton MP. Malrotation and intestinal atresias. Early Hum Dev. 2014;90(12):921-5.
Louw JH, Barnard CN. Congenital intestinal atresia: observations on its origin. Lancet. 1955;269(68899):1065-7.
Rao KL, Chowdhary SK, Suri S, Narasimhan KL, Mahajan JK. Duodenal atresia: Outcome analysis from a regional neonatal center. Indian Pediatr. 2001;38:1277-80.
Martin LW, Zerella JT. Jejunoileal atresia: a proposed classification. J Pediatr Surg. 1976;11(3):399-403.
Martin CE, Leonidas JC, Amoury RA. Multiple gastrointestinal atresias, with intraluminal calcifications and cystic dilatation of bile ducts: a newly recognized entity resembling “a string of pearls”. Pediatrics. 1976;57:268-71.
Tuschka O, Hyde D. Intestinal obstruction in newborn. WJM Calif Med. 1956;84(4):237-41.
Burjonrappa S, Crete E, Bouchard S. Comparative outcomes in intestinal atresia: a clinical outcome and pathophysiology analysis. Pediatr Surg Int. 2011;27(4):437-42.
Ando H, Kaneko K, Ito F, Seo T, Harada T, Watanabe Y. Embryogenesis of pancreaticobiliary maljunction inferred from development of duodenal atresia. J Hepatobil Pancreat Surg. 1999;6(1):50-4.
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(5):490-7.
Ohyama M, Itani Y, Yamanaka M, Imaizumi K, Nishi T, Ijri R, et al. Umbilical cord ulcer: a serious in utero complication of intestinal atresia. Placenta. 2000;21(4):432-5.
Huff DS. Developmental anatomy and anomalies of the gastrointestinal tract, with involvement in major malformative syndromes. In: Russo P, Ruchelli E, Piccoli D, eds. Pathology of Pediatric Gastrointestinal and Liver Disease. New York: Springer; 2004:3-37.
Knutrud O, Eek S. Combined intrinsic duodenal obstruction and malrotation. Acta Chir Scand. 19605;119:506-17.
Davenport M, Bianchi A, Doig CM, Gough DC. Colonic atresia: current results of treatment. J R Coll Surg Edinb. 1990;35(1):25-8.
Etensel B, Temir G, Karkiner A, Melek M, Edirne Y, Karaca I, et al. Atresia of the colon. J Pediatr Surg. 2005;40(8):1258-68.
Herman RS, Teitelbaum DH. Anorectal malformations. Clin Perinatol. 2012;39(2):403-22.
Elefant E, Jeklerova J, Le Breux L. Intestinal obstruction in a newborn with congenital atresia and volvulus caused by haemangioma of the small bowel. Case report. Clin Pediatr. 1970;9(5):287-9.
Heycock JB, Dickinson PH. Haemangiomata of the intestine. Br Med J. 1951;1(4707):620-1.
Louw JH. Congenital intestinal atresia and severe stenosis in the new born. S Afr J Clin Sci. 1952;3:209-34.
DeSa DJ. Congenital stenosis and atresia of the jejunum and ileum. J Clin Pathol. 1972;25(12):1063-70.
Louw JH. The pathogenesis of congenital abnormalities of the digestive tract. S Afr Med J. 1967;2:1057.
Walker K, Badawi N, Hamid CH, Vora A, Halliday R, Taylor C, et al. 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(3):484-8.
Feggetter S. Congenital intestinal atresia. Br J Surg. 1955;42:378.
Morison JE. Fetal and Neonatal Pathology, 2nd edn. London: Butterworths; 1963.
Santulli TV, Blanc WA. Congenital atresia of the intestine. Pathogenesis and treatment. Ann Surg. 1961;154(6):939-48.
Gaillard D, Bouvier R, Scheiner C, Nessmann C, Delezoide AL, Dechelotte P, et al. Meconium ileus and intestinal atresia in fetuses and neonates. Pediatr Pathol Lab Med. 1996;16(1):25-40.