Atresia, Stenosis, and Other Obstruction of the Colon Workup

  • Author: Nelson G Rosen, MD, FACS, FAAP; Chief Editor: Marleta Reynolds, MD   more...
 
Updated: Apr 6, 2010
 

Laboratory Studies

All children with neonatal bowel obstruction should have an electrolyte measurement, complete blood cell (CBC) count, and a crossmatch prior to operative intervention.

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Imaging Studies

Antenatal ultrasonography may reveal bowel loop distention or polyhydramnios.

Plain radiography of the abdomen reveals bowel obstruction and may reveal a prominent dilated loop. A prone view shows absence of gas in the rectum, although gas may be present if the film was obtained after the rectum was examined.

Contrast enema may be performed prior to surgery at the discretion of the surgeon and can be useful in ruling out the presence of other lesions downstream from the atresia. It reveals a microcolon with a rounded proximal end (see the image below).

Contrast enema showing microcolon with dilated proContrast enema showing microcolon with dilated proximal colon (colonic atresia of sigmoid colon).

Radiography in congenital colonic stenosis also reveals an obstructive pattern that may mimic atresia. Contrast enema reveals narrowing of the colon, with limited filling of the dilated proximal colon (see the image below).

Contrast enema revealing colonic stenosis at the hContrast enema revealing colonic stenosis at the hepatic flexure.
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Diagnostic Procedures

Rectal biopsy (performed either as a suction biopsy prior to surgical correction or at the time of operative correction) should be considered to evaluate for associated Hirschsprung disease.[43, 29] The association is quite rare; in a recent series of 12 patients, none were found to have Hirschsprung disease.[44]

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Contributor Information and Disclosures
Author

Nelson G Rosen, MD, FACS, FAAP  Assistant Professor of Surgery and Pediatrics, Albert Einstein College of Medicine; Attending Pediatric Surgeon and Director, Pediatric Trauma Center, Department of Pediatric General Surgery, Schneider Children's Hospital

Nelson G Rosen, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, American Trauma Society, Association of Military Surgeons of the US, Canadian Association of Pediatric Surgeons, and Eastern Association for the Surgery of Trauma

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey Zitsman, MD  Director, Center for Adolescent Bariatric Surgery, Associate Clinical Professor, Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York, New York Presbyterian Medical Center

Jeffrey Zitsman, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Jeremy T Aidlen, MD  Fellow in Pediatric Surgery, North Shore-Long Island Jewish Health System, Schneider's Children's Hospital

Jeremy T Aidlen, MD is a member of the following medical societies: American College of Surgeons and International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Specialty Editor Board

Kurt D Newman, MD  Vice Chairman, Department of Pediatric Surgery, Children's National Medical Center; Professor, Departments of Surgery and Pediatrics, George Washington University School of Medicine

Kurt D Newman, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Deborah F Billmire, MD  Associate Professor, Department of Surgery, Indiana University Medical Center

Deborah F Billmire, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Phi Beta Kappa, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD  Professor of Surgery, Feinberg School of Medicine, Northwestern University; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago

Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

References

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Colonic atresia, type 1 (sigmoid colon). The dilated colon abruptly tapers to unused distal segment.
Contrast enema showing microcolon with dilated proximal colon (colonic atresia of sigmoid colon).
Contrast enema revealing colonic stenosis at the hepatic flexure.
Abdominal radiograph of a baby with colonic atresia at the distal transverse colon. The colon proximal to the atresia is visible as a large dilated loop of intestine running obliquely across the abdomen.
This intraoperative photograph displays the proximal dilated segment in a patient with type 3 atresia of the distal transverse colon.
The small portion of bowel held on the right looks like an appendix but is actually the distal segment for the patient in the previous image, with type 3 atresia at the distal transverse colon.
Table. Outcomes of Surgery in Colonic Atresia and Stenosis
Author (Year)Number of PatientsProcedureSurvival Rate
Gross (1952)[10] 6Ostomy*33%
Sturim (1966)[48] 2Ostomy50%
Coran (1969)[49] 9Ostomy66%
Pohlson (1988)[21] 11Ostomy (6),



anastomosis (4)† ,



resection diaphragm (1)‡



73%
Smith (1989)[50] 2Not specified100%
Davenport (1990)[5] 11Ostomy (6);



anastomosis (4)



91%
Barrack (1993)[51] 2Anastomosis100%
Dalla Vecchia (1998)[11] 21Ostomy (18);



anastomosis (3)



100%
Abu-Judeh (2001)[47] 1Anastomosis100%
Dassinger (2009)[44] 12Ostomy (2);



anastomosis (10)



100%
Footnotes -*Ostomy, resection and staged anastomosis months later



† Resection with primary anastomosis



‡Cecotomy, resection of diaphragm



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