Ileal Atresia

Ileal and jejunal atresias are usually described together as jejunoileal atresia (JIA). JIA is a common cause of intestinal obstruction in neonates. It is seen in 1 in 5000 to 1 in 14000 live births. Intestinal atresia can occur in any location on the small bowel as a solitary or even multiple lesions. Distally located atresia usually presents with delayed symptoms compared to proximal ones. Occasionally, JIA is associated with other malformations such as cardiac anomalies, gastroschisis, and cystic fibrosis.  Evaluation can be initiated before birth with prenatal diagnosis using ultrasound findings of evidence of intestinal obstruction reported in 29% to 50% of cases. Postnatally, the patient presents with signs and symptoms of intestinal obstruction, and diagnosis is made with a plain abdominal radiograph, which shows proximal distended bowel with no distal bowel gas. Advances in pediatric anesthesia, pediatric surgery, intensive care unit (ICU) care, and nutritional supports over the years have led to better overall survival in patients with intestinal atresia. Treatment is individualized in most cases and involves resuscitation with intravenous fluid, correction of electrolytes and acidosis, gastric decompression with a nasogastric tube, and operative intervention. The traditional surgical approach is transverse supraumbilical laparotomy, but in recent years minimally invasive approaches such as circumumbilical incisions and laparoscopic-assisted techniques are being widely adopted. This article aims to review the causes, course, clinical features, evaluation, and recent trends in the management of JIA.