Discussion
Colonic atresia (CA) is a rare form of congenital intestinal atresia. Although CA may be isolated, it is more commonly reported in literature in association with other congenital anomalies.
Associated anomalies
Associated anomalies vary between abdominal anomalies (abdominal wall defect, multiple intestinal atresia, Hirschsprung's disease, and malrotation) and extra abdominal anomalies (musculoskeletal, ocular, and facial anomalies)
Pathogenesis
There are two main different theories may explain this anomaly : The classic vascular incident theory that can be caused by an intrinsic factor like thrombo-embolic event originating from the placenta and passing into the fetal circulation occluding a mesenteric blood vessels or extrinsic mesenteric vascular obstruction associated with internal hernia, volvulus or strangulation in tight gastroschisis This vascular insult occurs mostly late in gestation and leads to either the isolated phenotype of CA or the CA associated with abdominal wall defects such as gastroschisis. Colonic atresia associated with a choledochal cyst may be attributed to the intrauterine direct pressure effect of the cyst on the transverse colon mesentery
Diagnosis
Antenatal diagnosis of colonic atresia is difficult, though dilated bowel loops may be seen as multiple echo-free areas, in foetal abdomen on sonographic examination.Diagnosis needs a high index of suspicion especially when facing a case of low intestinal obstruction with failure of the meconium to pass as there is always an incidence of delayed and missed diagnosis.
Prognosis
The presence of associated major anomalies has a poor prognosis. Another important issue affecting the prognosis of these cases is the early diagnosis and management. Etensel and his colleagues observed a significant higher mortality rate with delayed diagnosis and surgical intervention for more than 72 hours from birth
References
- Etensel B, Temir G, Karkiner A, Melek M, Edirne Y, Karaca I, et al. Atresia of the colon. J Pediatr Surg. 2005;40:1258-68.
- Della Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg. 1998;133:490–6.
-Puri P, Fujimoto T. New observations on the pathogenesis of multiple intestinal atresias. J Pediatr Surg. 1988;23:221-5.
-Soni V, Valse PD, Vyas S. Colonic atresia due to internal herniation through the falciform ligament defect: A case report. J Neonat Surg. 2014; 3:21-2.Baglaj M, Carachi R, MacCormack B. Colonic atresia: a clinicopathological insight into its etiology. Eur J Pediatr Surg. 2010;20:102-5.