Atresia, Stenosis, and Other Obstruction of the Colon Clinical Presentation

Updated: Sep 26, 2017
  • Author: Nelson G Rosen, MD, FACS, FAAP; Chief Editor: Eugene S Kim, MD, FACS, FAAP  more...
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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.