Helicobacter pylori - Portal Neonatal

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Congenital problems of the gastrointestinal tract
a functional and cosmetic state as possible. In the
majority of cases the initial surgery involves
forming a colostomy in the descending or sigmoid
colon to allow intestinal drainage and avoid dilatation
of the lower bowel. 41 Following assessment,
planning of surgery and growth of the infant reconstructive
surgery is undertaken most commonly by
the posterior sagittal approach. 42 Some anomalies
also require a laparotomy to divide a high
rectovesical fistula. Surgery of these cases and
particularly of the cloaca is complex and should be
performed by an experienced surgeon.
Outcome
In similarity to patients with Hirschsprung’s
disease, incontinence and constipation are the
most significant long-term complications of
surgically treated anorectal anomalies and often
have a significant impact on quality of life. In one
large series, soiling occurred in 57% of 387 cases.
The incidence of fecal incontinence was 25% and
constipation 43.1%. 42 Ongoing medical and, on
occasion, surgical treatment is necessary to minimize
disruption to a normal lifestyle.
Conditions which may occur at any
point in the gastrointestinal tract
Gastrointestinal duplications
Duplication cysts of the GI tract are rare congenital
abnormalities. They can occur at any point in
the GI tract from mouth to anus, although they are
most commonly found around the ileocecal region.
Duplication cysts are defined according to strict
criteria, as devised by Ladd and Gross; they are
closely attached to some part of the GI tract, have
a smooth muscle coat and have an epithelial lining
that resembles some part of the alimentary canal. 43
Duplications may be spherical or tubular in macroscopic
appearance, those that are tubular accounting
for 10–20% and often having a communication
with the bowel.
Clinical features
Between 25 and 30% present in the neonatal
period and most have presented by the age of 10
years. Clinical features at presentation depend on
anatomical site, size and secondary effects and
include an oropharyngeal, abdominal or rectal
mass, respiratory distress, GI bleeding, obstruction
and intussusception. Duplication cysts may also
be found as incidental findings at laparotomy and
some lesions have been detected on antenatal
ultrasound examination. 44,45
Treatment
The recommended management of duplication
cysts is complete surgical excision wherever possible,
in order to prevent recurrence and complications
secondary to ectopic gastric mucosa. When
complete excision is not possible it is essential to
remove the mucosal lining.
Conditions affecting the walls of the
abdominal cavity
Whilst not truly conditions of the GI tract, there
are a number of conditions that cause the abdominal
contents to develop outside the abdominal
cavity. These conditions are included as they have
secondary effects which may significantly affect
the GI tract and be a cause of GI dysfunction.
Congenital diaphragmatic hernia
The incidence of congenital diaphragmatic hernia
varies from 1 in 3500 to 1 in 5000 live births. 46 Its
etiology is unknown, although it is probably multifactorial.
The essential anatomical defect is a
breach in the continuity of the diaphragm which
allows herniation of the abdominal viscera into the
thoracic cavity. This has a secondary effect of
impeding development of the lungs during
intrauterine life. The resulting hypoplastic lungs
are a cause of significant morbidity and mortality
in this condition. Compression by misplaced
abdominal contents does not explain the severity
of lung disease seen and it is well recognized that
lung development is markedly abnormal in infants
with congenital diaphragmatic hernia.
Classification
A number of different defects can occur, owing to
the complex development of the diaphragm. The