Atresia, Stenosis, and Other Obstruction of the Colon Clinical Presentation: History and Physical Examination

Sections

Atresia, Stenosis, and Other Obstruction of the Colon

Sections Atresia, Stenosis, and Other Obstruction of the Colon
Overview
Presentation
Workup
Treatment
Media Gallery
Tables
References

Presentation

History and Physical Examination

Patients with colonic atresia or congenital stenosis may sometimes have characteristic findings on antenatal ultrasonography, such as dilated bowel loops or the presence of polyhydramnios. Initial physical examination findings are normal in the absence of associated conditions. The anus usually appears normal. Progressive abdominal distention develops. Rectal examination reveals white or pale mucus rather than pigmented meconium.

Failure to pass meconium completely suggests atresia, whereas delayed passage of meconium (>24 hours) suggests Hirschsprung disease. Patients with colonic atresia may pass meconium normally because the incident that caused the atresia may have occurred after the colon had become filled with meconium.

Colonic stenosis usually follows some form of injury to the colon, sustained either in utero or postnatally, and ischemia is considered central to the insult. The infant or child may present with symptoms similar to atresia with high-grade stenosis; less stenotic lesions may not become apparent until feeding is undertaken. In those instances, the child’s abdomen may become distended with feeding, and stool production is scant, if present.

Babies with necrotizing enterocolitis may show signs of acquired stenosis after their acute episode. When the septic signs of the illness resolve and the child is doing well, feeding is often attempted. If a stenosis has formed, the baby usually will not tolerate feedings, and the abdomen will become distended. Studies may be performed to confirm the diagnosis and to try to localize the site of narrowing, at the discretion of the surgeon.

Workup

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Media Gallery

Colonic atresia, type 1 (sigmoid colon). 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 hepatic flexure.
Abdominal radiograph of baby with colonic atresia at distal transverse colon. Colon proximal to atresia is visible as large dilated loop of intestine running obliquely across abdomen. Courtesy of Richard Glick, MD.
Intraoperative photograph displays proximal dilated segment in patient with type 3 atresia of distal transverse colon. Courtesy of Richard Glick, MD.
Small portion of bowel held on right looks like appendix but is actually distal segment for patient with type 3 atresia at distal transverse colon. Courtesy of Richard Glick, MD.

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Author (Year)	No. of Patients	Procedure	Survival Rate
Gross (1952)^[19]	6	Ostomy*	33%
Sturim (1966)^[30]	2	Ostomy	50%
Coran (1969)^[31]	9	Ostomy	66%
Pohlson (1988)^[32]	11	Ostomy (6), anastomosis (4),† resection of diaphragm (1)‡	73%
Smith (1989)^[33]	2	Not specified	100%
Davenport (1990)^[7]	11	Ostomy (6), anastomosis (4)	91%
Barrack (1993)^[34]	2	Anastomosis	100%
Dalla Vecchia (1998)^[20]	21	Ostomy (18), anastomosis (3)	100%
Abu-Judeh (2001)^[28]	1	Anastomosis	100%
Dassinger (2009)^[35]	12	Ostomy (2), anastomosis (10)	100%
*Ostomy, resection and staged anastomosis months later. †Resection with primary anastomosis. ‡Cecotomy, resection of diaphragm.

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, Eastern Association for the Surgery of Trauma, Canadian Association of Pediatric Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Eugene S Kim, MD, FACS, FAAP Associate Professor of Surgery, Division of Pediatric Surgery, Keck School of Medicine of the University of Southern California; Attending Pediatric Surgeon, Children's Hospital Los Angeles

Eugene S Kim, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, Society of University Surgeons, Texas Medical Association, Children's Oncology Group

Disclosure: Nothing to disclose.

Acknowledgements

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