Proximal colonic atresia: is right hemicolectomy inevitable?

• Published in: Pediatric surgery international Vol. 27; no. 10; pp. 1059 - 1062
• Main Authors: England, Richard J., Scammell, Simon, Murthi, Govind V.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.10.2011; Springer Nature B.V
• Subjects: Colectomy; Colon - abnormalities; Colostomy; Female; Humans; Ileocecal Valve; Infant; Infant, Newborn; Intestinal Atresia - surgery; Male; Medicine; Medicine & Public Health; Organ Sparing Treatments; Original Article; Pediatric Surgery; Pediatrics; Retrospective Studies; Surgery; Infant; Colostomy; Intestinal atresia; Newborn; Colon
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-011-2957-6

Purpose Proximal colonic atresia often results in a marked discrepancy of the atretic ends presenting a technical challenge for restoration of bowel continuity. We review our series of colonic atresia patients with particular reference to the techniques for restoring bowel continuity. Methods Case notes of all patients diagnosed with colonic atresia and admitted to our unit between 1997 and 2011 were reviewed. Results There were 13 patients with a median gestational age of 39 weeks. Location of the atresia was ascending colon ( n  = 1), hepatic flexure ( n  = 9), proximal transverse colon ( n  = 2) and sigmoid colon ( n  = 1). The primary procedure was: primary anastomosis ( n  = 1), right hemicolectomy followed by ileo-colic anastomosis ( n  = 2), right hemicolectomy and stoma formation ( n  = 3). Six patients underwent stoma formation, of which five subsequently had a right hemicolectomy at a later procedure. In total, 10/12 patients required right hemicolectomy to facilitate restoration of bowel continuity. Median time to full feeds was 11 days (4–46). Median follow up time was 11 months (22 days–5.6 years). Conclusion A temporising stoma does not reduce the discrepancy in the calibre of the atretic ends in proximal colonic atresia. Right hemicolectomy and ileo-colic anastomosis should therefore be considered at the initial surgery.