Congenital small intestinal atresia and stenosis

　　Currently, there is no theory that can fully explain the causes of various types of congenital small intestinal atresia and stenosis. Since the 1950s, many scholars have proposed several causes of fetal small intestinal atresia through animal experiments and clinical research, as follows:

　　1. Fetal intestinal injury and mesenteric vascular accident

　　Extensive experimental research has proven that any cause that leads to fetal intestinal injury and mesenteric vascular ischemia can result in intestinal atresia and stenosis.

　　2. Familial genetic factors

　　Lewis (1953) reported a case of twin children with type I ileal atresia. Blyth and Dickon (1960) reported that 8 people in two families had Apple-Peel atresia, and there have been continuous similar reports ever since.

　　3. Abnormal development of the superior mesenteric artery

　　Jimenez and Reiner performed arteriography on post-mortem children with congenital small intestine atresia and stenosis and found malformation of the superior mesenteric artery.

　　4. Embryonic intestinal cavity obstruction

　　Some scholars believe that the atresia and stenosis of the upper esophagus, duodenum, upper jejunum, and colon are caused by incomplete emptying of the intestinal tube during embryonic development.

　　The postoperative complications of congenital small intestine atresia and stenosis mainly include the following:

　　1. Anastomotic obstruction

　　Anastomotic obstruction is the most common postoperative complication, including functional and mechanical obstruction.

　　2. Anastomotic leakage

　　In advanced cases, complications such as water and electrolyte disorders, hypoproteinemia, vitamin deficiency, or jaundice can affect the formation of collagen fibers at the anastomosis and tissue healing.

　　3. Necrotizing enterocolitis

　　Poor microcirculatory perfusion after surgery can trigger necrotizing enterocolitis.

　　The clinical manifestations of congenital intestinal atresia or stenosis are mainly the symptoms of intestinal obstruction, and the timing and severity of the symptoms depend on the location and degree of obstruction. Intestinal atresia is a complete intestinal obstruction, the main symptoms being vomiting, abdominal distension, and constipation. Vomiting usually occurs after the first feeding or on the first day after birth, and the timing of its onset is related to the location of the atresia. Duodenal and high intestinal atresia present early and frequently, while ileal, colonic atresia, etc., can appear 2-3 days after birth. After vomiting occurs, it becomes progressive and severe, with a large amount of vomit. The vomit in the case of high intestinal atresia is milk clots, which often contain bile.

　　Congenital small intestine atresia and stenosis belong to congenital malformations. The prevention of congenital malformations includes the following aspects:

　　1. In the early stages of pregnancy, pregnant women should avoid fever and cold. High fever can cause fetal malformation and is related to the sensitivity of pregnant women to high fever and other factors.

　　1. Pregnant women should avoid getting close to cats and dogs. Infected cats are also a major source of infectious diseases that can threaten fetal malformation.

　　2. Pregnant women should avoid wearing heavy makeup every day. Toxic substances such as arsenic, lead, and mercury in cosmetics can affect the normal development of the fetus.

　　3. Pregnant women should avoid emotional stress during pregnancy. When pregnant women are emotionally stressed, adrenal cortical hormones may hinder the integration of embryonic tissue. If it occurs in the first three months of pregnancy, it can cause fetal malformation.

　　4. Pregnant women should avoid drinking alcohol. Alcohol can pass through the placenta to harm the developing fetus severely.

　　The auxiliary examinations for congenital small intestine atresia and stenosis mainly include the following:

　　1. Abdominal X-ray film

　　Abdominal X-ray film is of great value in diagnosing intestinal atresia and stenosis. In the case of intestinal stenosis, a barium meal examination is often required to make the diagnosis clear. Under fluoroscopy, barium can be seen to accumulate at the obstruction site, with only a small amount of barium passing through the stenotic segment into the distal intestinal cavity.

　　2. Prenatal ultrasound examination

　　Prenatal B-ultrasound scan is very valuable for diagnosing fetal small intestine atresia. High-position jejunal atresia shows a long-shaped fluid area extending from the stomach to the proximal jejunum, or several dilated jejunal fluid areas are detected in the upper abdominal cavity of the fetus.

　　In terms of diet, the following points should be noted for congenital small intestine atresia and intestinal stenosis:

　　1. For the first week after surgery, semi-liquid foods can be eaten, such as noodles, wontons, millet and red bean porridge, buns, bread, soda crackers, braised tofu, steamed fish, and braised fresh vegetable ends, etc.

　　2. Eat easily digestible and defecation-promoting foods such as kelp, pork blood, carrots, hawthorn, pineapple, papaya, etc.

　　3. Eat more fiber-rich foods such as various vegetables, fruits, brown rice, whole grains, and beans, which can help defecate and prevent constipation.

　　4. Eat processed or cooked foods that are easy to chew and digest. Eggs can be eaten 1-2 times a week. Diversified intake of the six major food categories such as dairy products, grains and roots, meat, fish, beans, eggs, vegetables, fruits, and oils is recommended to fully obtain various nutrients.

　　5. Eat foods rich in protein and iron, such as lean meat, fish and shrimp, animal blood, animal liver and kidney, egg yolk, soy products, as well as jujube, green leafy vegetables, sesame paste, etc.

　　6. Choose vegetable oils, and mostly use methods such as boiling, steaming, and cold dressing. Avoid high-cholesterol foods such as fatty meat, internal organs, fish eggs, butter, etc.

　　Once the diagnosis of congenital small intestine atresia and intestinal stenosis is established, rapid preoperative preparation and surgery should be performed. Patients with good overall condition should receive an appropriate amount of 2:1 10% glucose solution plus Ringer's solution or normal saline before surgery. If dehydration and electrolyte imbalance exist, dehydration and acidosis should be corrected. The main surgical methods include surgery for single-type atresia of the jejunum and ileum, surgery for proximal atresia of the jejunum, and surgery for multiple atresia.