Jejunoileal atresia and stenosis

Evidence has been submitted in favor of treating jejunoileal atresias by resection of the blind ends and primary end-to-end anastomosis. This evidence is based on the following: 1. 1. A clinicopathologic study of 151 cases of intestinal atresia including 85 cases with jejunoileal lesions. 2. 2. The experimental production of intestinal atresia in animals. 3. 3. The treatment of 33 consecutive cases of jejunoileal atresia by resection and primary anastomosis. The clinicopathologic data revealed that many of the deaths were due to technical failures and that the principal factor responsible for the failures was impaired viability and contractility of the bulbous end of the proximal bowel. This appeared to be due to deficient blood supply which in turn might be related to the pathogenesis of the lesions. Further analysis of the clinical material provided evidence that jejunoileal atresia probably results from accidental interference with the blood supply of a segment of the fetal bowel by strangulating obstructions occurring as isolated events late during intrauterine life. The experiments proved conclusively that atresia and stenosis may be caused by such a mechanism. Having obtained this evidence in favor of resection, all subsequent cases of jejunoileal atresia have been treated by resection of at least 10 to 15 cm. of the proximal dilated bowel and primary anastomosis. Since 1955, 33 cases have been treated by the method with 3 deaths (survival rate 91 per cent). In the first 9 cases a side-to-side anastomosis was done. There were 2 deaths and among the survivors one developed an anastomotic leak and 2 have suffered from nutritional problems due to the blind loops. In the subsequent 24 cases, end-to-end anastomosis was performed. There has been only one death (survival rate 96 per cent). The loss of up to 30 cm. of bowel has not caused any long-term problems, and only one child, who had 20 cm. of jejunum resected, has remained underweight but otherwise well. It is concluded that resection and primary end-to-end anastomosis is a rational and safe procedure for the treatment of jejunoileal occlusions but that there may occasionally be a place for a multi-staged Mikulicz resection in premature infants and those with severe associated abnormalities. © 1966.