Zeynep Kamil Med J. 2015; 46(1): 45-50

Effecting Factors of The Mortality and Morbidity in The Jejunoileal Obstruction

Vedat Akçaer, Ayþenur Cerrah Celayir, Inanç Cici, Serdar Moralýoðlu
Zeynep Kamil Gynecology and Child Diseases Educ. and Res. Hospital, Pediatric Surgery, Istanbul, Turkey

INTRODUCTION: Jejunoileal atresia and meconium ileus are seen common among major causes of intestinal obstructions of the newborns requiring emergency surgical treatment. The aim of this study is determined effecting factors of the mortality and morbidity in the jejunoileal obstruction in newborns.
METHODS: This study is designed as a retrospectively from all records of the neonates with jejunoileal obstructions hospitalised in between January
2004 and January 2013.
RESULTS:
DISCUSSION AND CONCLUSION: 44 newborns were opertated due jejunoileal obstruction during the 9 years period. 34 of them were intestinal atresia (77,2%), the others had meconium ileus. Prenatal diagnosis was suggestive of intestinal obstruction in 15 fetuses (44%). %41of 34 intestinal atresia was premature. At the time of surgery, 34 (77,2%) of the jejunoileal atresias were classified 6(17,6%) as type I(mucosal), 8(23,5 %) as type II(atretic fibrous cord), 5(14,2 %) as type IIIa(V-shaped mesenteric defect), 11(24,4%) as type IIIb(“apple peel” atresia), and 4(11,8%) as type IV(-multiple atresias). Other findings in operation had included malrotation in 9(20,4%), meconium peritonitis in 1(2,9%), Meckel diverticulum in 1(2,9%), and intrauterine intussusception in 1(2,9%). Operative management included resection of the atresia with primary bowel anastomosis in 28 neonates (82,3%), temporary ostomy in 2(5,8%), with intestinal resection in 30(88,1% of those), enterotomy with web excision in 1(2,9%). Ladd procedure was performed in those neonates with malrotation 9(20,4%) and Meckel diverticulectomy was performed in 1 neonate, and incidental appendectomy was performed in 4 neonates (11,6%). Following resection, 1 patients (2,9%) had resultant short-bowel syndrome. Mortality for neonates with with jejunoileal atresia was 7 cases (20,5%). Ten neonates (22,7 %) had cystic fibrosis documented by sweat chloride determinations. The long-term survival rate for children with jejunoileal atresia, 79,5%; and with meconium ileus 90%.

Keywords: jejunum, ileum; atresia; cystic fibrosis; short bowel syndrome; total parenteral nutrition; meconium; ileus; surgery; child.

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