CONGENITAL COLONIC ATRESIA PRESENTING AS PNEUMOPERITONEUM: A RARE CLINICAL ENTITY

Introduction:Colonic Atresia is the least common type of Intestinal Atresia which occurs as a result of ischemic necrosis of a segment of large intestine.It presents with abdominal distention,bilious vomiting and failure to pass meconium.Perforation leads to peritonitis and sepsis Case Report:We describe a 3 day old male baby presenting with Colonic Atresia type IIIa and pneumoperitoneum and his surgical management Conclusion:In conclusion, Colonic Atresia is managed by either by colostomy or primary anastomosis.Terminal ileostomy,as in this case is done when there is Ascending Colon atresia with distal ileal perforation.

Gastroschisis Complicated by Colonic Atresia

Introduction: Gastroschisis with colonic atresia is a rare association. Due to its rarity and variation in presentation, no standardized surgical treatment option exists. Complicated gastroschisis is associated with a higher morbidity and mortality than intestinal atresia or gastroschisis alone. Methods: This is a case report of a neonate with congenital gastroschisis. On day of life 1, a silo was placed. On day of life 4, the upper portion of silo contents appeared more congested with dusky discoloration and the patient was oliguric. She was taken to the operating room for exploration. Results: The patient required resection of the terminal ileum and an atretic portion of the cecum due to necrosis. Four days later, primary closure of the gastroschisis defect was performed with creation of an end ileostomy. Elective ileostomy takedown was performed 5 months later. She returned to the operating room for anastomotic revision and gastrostomy tube placement for intestinal dysmotility and prolonged ileus. Tube feedings were discontinued 3 months post-operatively. Conclusions: Gastroschisis with intestinal atresia is associated with increased hospital length of stay, longer duration of parenteral nutrition, more severe intestinal dysfunction, increased surgical complications, and higher mortality than gastroschisis or intestinal atresia alone. With associated colonic atresia, loss of a significant length of bowel due to necrosis, including the ileocecal region, is almost unavoidable. An already compromised blood supply to the atretic bowel is further impaired by a tight abdominal wall defect and postnatal increases in gravitational force. Complicated gastroschisis remains a complex surgical challenge requiring further discussion.

Feasibility of primary anastomosis for right-sided colonic atresia: A case report

Background: Colonic atresia (CA) is a rare cause of congenital intestinal obstruction. The management of CA is challenging because of its rarity. Case Presentation: We present a case of right-sided CA in a term male baby weighing 3006 gm, without any other comorbidity. Type 1 atresia was seen at ascending colon and upon decompression, a reasonable caliber was achieved for a primary anastomosis following distal Cheatle slit and proximal tapering. Postoperative recovery was uneventful. Conclusion: Primary anastomosis is a feasible option in right-sided CA when no major comorbidity is present and a normal distal colon with reasonable caliber is certain.

Colonic and type IV jejunal atresias with apple-peel bowel segment as the content of right inguinal hernia: A case report

Background: Colonic atresia is an uncommon entity. It may be associated with multiple anomalies. Case Presentation: We present a case, which was initially suspected to be jejunal atresia, but was found to have colonic atresia as well intra-operatively. The associated jejunal atresia with apple-peel configuration was present as the content of inguinal hernia. Conclusion: This case report highlights the rarity of the condition and the postoperative issues in the management of such patients.

Congenital pouch colon with colonic atresia- An unusual embryological association: A case report

Background: Congenital pouch colon (CPC) is a rare variant of high anorectal malformation. More and more varied associations of CPC with other entities are being added to the literature. Case presentation: A 1-day-old male baby presented to the emergency room with marked abdominal distension and absent anal opening. On exploration, the baby was found to have CPC (Type 2) with colonic atresia. This association has not been reported in English literature. Conclusion: This is a report of a case of type 2 CPC with colonic atresia. To the best of our knowledge, such an association has not been reported so far. The final embryological outcome is dictated both by the topography and timing of vascular insult.

STUDY IN PAEDIATRIC AGE GROUP UNDERGOING EMERGENCY LAPAROTOMY : OBSERVATIONAL STUDY

INTRODUCTION: Acute abdomen can be defined as “syndrome included by wide variety of pathological conditions that require emergent medical or more often surgical management.” Acute abdomen is caused due to gastrointestinal diseases such as intestinal obstruction and perforation peritonitis. AIM: The aim of our study was to observe the common cause in paediatric age group undergoing emergency laprotomy in our institutions. MATERIAL AND METHODS:This prospective study included 77children aged below or equal to 15years, underwent emergency laprotomy for acute intestinal conditions between January 2019 to December 2019 in RIMS,RANCHI. We excluded neonates ,patients of jejunoileal colonic atresia and stenosis, anorectal malformation(ARM), congenital pouch colon, neonatal necrotizing enterocolitis(NEC), hirschprung’s disease, gastrointestinal tumor. RESULTS: Total of 77 laprotomies were performed in emergency in children below or equal to 15 years age,59(76.62% ) were boys and 18(23.37% )were girls with male:female ratio of 3.2:1. 36(46.75%) cases were done for acute intestinal obstruction and 41(53.24%) cases were done for perforation peritonitis.20(25.97%)emergency laprotomy was performed in the age group 1-5 years and 57(74.02% ) were performed in the age group 5-15 years. Causes in order of frequency for intestinal obstruction were intussusceptions, post operative band/adhesion, abdominal tb obstruction, meckel’s diverticulum and worm obstruction. Causes in order of frequency for perforation peritonitis were typhoid, abdominal tb, appendicular perforation and abdominal trauma. CONCLUSION: In our study maximum emergency laprotomy was performed in male patients with male:female ratio of 3.2:1. Perforation peritonitis was more common than acute intestinal obstruction. 5-15 year age group were more commonly affected. Typhoid ileal perforation was the most common cause for emergency laprotomy followed by intussusception.