Anemia of Prematurity - Portal Neonatal

duodenal atresia, the obstruction lies distal to the ampulla or is incomplete. In these situations,
vomiting is bilious. The abdomen is usually distended by the dilated duodenal loop but may be
scaphoid if the obstruction is incomplete. Preoperative treatment for these patients includes fluid
resuscitation and nasogastric decompression.
Consultation with a cardiologist and echocardiography may be helpful because of the high incidence
of associated anomalies. If the obstruction is incomplete as evidenced by some distal gas on plain
radiography, urgent laparotomy may be necessary to differentiate duodenal atresia from malrotation
with volvulus. Surgery involves resection or bypass of the atretic segment. A web must be identified
and completely resected to the degree that it no longer obstructs the distal lumen.
Many pediatric surgeons bypass rather than resect the atretic segment to avoid injury to the ampulla
or to the pancreatic blood supply that usually is nearby. A severely dilated duodenum may require a
tapering duodenoplasty to mitigate the poor long-term duodenal motility that can be observed in these
dilated proximal segments. A nasoenteric feeding tube is often placed across the duodenal
anastomosis for early decompression and late feeding.
Jejunoileal atresia
Atresia of the jejunum or ileum is more common than duodenal atresia, occurring in 1 in 1500 births.
Small-bowel obstruction from jejunoileal atresia may also lead to polyhydramnios. Premature delivery
is observed in one third of patients with intestinal atresia.
In contrast to duodenal atresia, jejunoileal atresia is widely considered to be a condition acquired
during development, rather than a preprogrammed anomaly. In classic work on fetal dogs in 1955,
Louw and Barnard demonstrated the pathophysiology by which intrauterine mesenteric vascular
accidents produce atresia in the segment of intestine that is devascularized. The extent of atresia and
the appearance of the atretic intestinal segment vary according to the timing and degree of the
disruption of the mesenteric blood supply. Atresias may be focal or multiple throughout the small
bowel. Interruption of the main superior mesenteric blood supply can result in atresia of most of the
jejunum and ileum. Other abdominal conditions, such as gastroschisis or intrauterine intussusception,
may be associated with intestinal atresia, presumably from kinking, stretching, or otherwise disrupting
the blood supply to the fetal bowel. Chromosomal anomalies are rare (