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Jejuno-Ileal Atresia and Stenosis

  • Alastair J. W. Millar
  • Alp Numanoglu
Chapter

Abstract

Successful outcome after surgery for atresia of the small intestine is still sometimes accompanied by significant complications. An understanding of the aetiology and the realization that the proximal blind ending dilated bulbous atretic bowel was the cause of most of these complications and resection of this segment with primary anastomosis of proximal to distal bowel led to a dramatic improvement in outcomes from a mortality of 90—100% to a survival of over 80% in the 1950’s. Subsequent improvement in some technical aspects of bowel anastomosis and neonatal perioperative care along with advances in nutrition both parenteral and enteral have made current treatment one of the many success stories of neonatal surgery.

Keywords

Intestinal atresia Aetiology Pathogenesis Classification Surgery Outcomes 

References

  1. 1.
    de Lorimier A. Congenital atresia and stenosis of the jejunum and ileum. Surgery. 1969;65:819.Google Scholar
  2. 2.
    Stollman TH, de Blaauw I, Wijnen MH, van der Staak FH, et al. Decreased mortality but increased morbidity in neonates with jejunoileal atresia; a study of 114 cases over a 34-year period. J Pediatr Surg. 2009;44(1):217–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Evans CH. Atresias of the gastrointestinal tract. Int Abstr Surg. 1951;92(1):1–8.PubMedGoogle Scholar
  4. 4.
    Louw JH. Congenital atresia and stenosis of the small intestine. The case for resection and primary end-to-end anastomosis. S Afr J Surg. 1966;4(2):57–64.PubMedGoogle Scholar
  5. 5.
    Louw JH. Resection and end-to-end anastomosis in the management of atresia and stenosis of the small bowel. Surgery. 1967;62(5):940–50.PubMedGoogle Scholar
  6. 6.
    Louw JH. Congenital jejunoileal atresia: observations on its pathogenesis and treatment. Z Kinderchir. 1980;33(1):3–17.Google Scholar
  7. 7.
    Nixon HH. Intestinal obstruction in the newborn. Arch Dis Child. 1955;30(149):13–22.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Nixon HH. An experimental study of propulsion in isolated small intestine, and applications to surgery in the newborn. Ann R Coll Surg Engl. 1960;27:105–24.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Cywes S, Davies MR, Rode H. Congenital jejuno-ileal atresia and stenosis. S Afr Med J. 1980;57(16):630–9.PubMedGoogle Scholar
  10. 10.
    Grosfeld JL, Ballantine TV, Shoemaker R. Operative mangement of intestinal atresia and stenosis based on pathologic findings. J Pediatr Surg. 1979;14(3):368–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Lloyd DA. J.H. Louw Memorial Lecture. From puppy dogs to molecules: small-bowel atresia and short-gut syndrome. S Afr J Surg. 1999;37(3):64–8.PubMedGoogle Scholar
  12. 12.
    Kumaran N, Shankar KR, Lloyd DA, Losty PD. Trends in the management and outcome of jejuno-ileal atresia. Eur J Pediatr Surg. 2002;12(3):163–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Hays, D., Intestinal atresia and stenosis. 1969.Google Scholar
  14. 14.
    Burjonrappa SC, Crete E, Bouchard S. Prognostic factors in jejuno-ileal atresia. Pediatr Surg Int. 2009;25(9):795–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Dalla 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(5):490–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Benson CD. Resection and primary anastomosis of the jejunum and ileum in the newborn. Ann Surg. 1955;142(3):478–85.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Bland Sutton J. Imperforate ileum. Am J Med Sci. 1889;98:457.CrossRefGoogle Scholar
  18. 18.
    Davis D. Congenital occlusions of the intestine. SGO. 1922;34:12.Google Scholar
  19. 19.
    Fockens P. Operativ geheilter Fall von kongenitaler Dunndarmatresie. Zentralbl Chir. 1911;38:532.Google Scholar
  20. 20.
    Louw JH. Congenital intestinal atresia and severe stenosis in the newborn; a report on 79 consecutive cases. S Afr J Clin Sci. 1952;3(3):109–29.PubMedGoogle Scholar
  21. 21.
    Spriggs N. Congenital intestinal occlusion. Guys Hosp Rep. 1912;66:143.Google Scholar
  22. 22.
    Tandler J. Zur Entwicklungsgeschichte des menschlichen duodenum in fruhen Embryonalstadien. Morphol Jahrb. 1900;29:187–219.Google Scholar
  23. 23.
    Louw JH, Barnard CN. Congenital intestinal atresia; observations on its origin. Lancet. 1955;269(6899):1065–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Millar A. Intestinal atresia and stenosis. Pediatric Surgery. 3rd ed; 2000.Google Scholar
  25. 25.
    Goulet OJ, et al. Neonatal short bowel syndrome. J Pediatr. 1991;119(1 ( Pt 1)):18–23.CrossRefPubMedGoogle Scholar
  26. 26.
    Gupte GL, et al. Current issues in the management of intestinal failure. Arch Dis Child. 2006;91(3):259–64.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Hoehner JC, Ein SH, Kim PC. Management of gastroschisis with concomitant jejuno-ileal atresia. J Pediatr Surg. 1998;33(6):885–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Smith GH, Glasson M. Intestinal atresia: factors affecting survival. Aust N Z J Surg. 1989;59(2):151–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Francannet C, Robert E. Epidemiological study of intestinal atresias: central-eastern France Registry 1976–1992. J Gynecol Obstet Biol Reprod (Paris). 1996;25(5):485–94.Google Scholar
  30. 30.
    Best KE, Tennant PWG, Rankin J. Small intestinal atresia in europe: prevalence, associated anomalies and pregnancy outcomes. Arch Dis Childhood Fetal Neonatal Ed. 2011;96(1):Fa56–7.CrossRefGoogle Scholar
  31. 31.
    Adeyemi D. Neonatal intestinal obstruction in a developing tropical country: patterns, problems, and prognosis. J Trop Pediatr. 1989;35(2):66–70.CrossRefPubMedGoogle Scholar
  32. 32.
    Cragan JD, Louise Martin M, Moore CA, Khoury MJ. Descriptive epidemiology of small intestinal atresia, Atlanta, Georgia. Teratology. 1993;48(5):441–50.CrossRefPubMedGoogle Scholar
  33. 33.
    Ratan SR, et al. Surgically treated gastro-intestinal obstruction in children: causes and implications. Indian J Gastroenterol. 2006;25(6):320–2.PubMedGoogle Scholar
  34. 34.
    Bishop HC, Koop CE. Management of meconium ileus; resection, Roux-en-Y anastomosis and ileostomy irrigation with pancreatic enzymes. Ann Surg. 1957;145(3):410–4.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Haller JA Jr, et al. Intestinal atresia. Current concepts of pathogenesis, pathophysiology, and operative management. Am Surg. 1983;49(7):385–91.PubMedGoogle Scholar
  36. 36.
    Nixon HH, Tawes R. Etiology and treatment of small intestinal atresia: analysis of a series of 127 jejunoileal atresias and comparison with 62 duodenal atresias. Surgery. 1971;69(1):41–51.PubMedGoogle Scholar
  37. 37.
    Nguyen D. In utero intussusception producing ileal atresia and meconium peritonitis with and without free air. Pediatr Surg Int. 1995;10:406.CrossRefGoogle Scholar
  38. 38.
    Santulli TV, Blanc WA. Congenital atresia of the intestine: pathogenesis and treatment. Ann Surg. 1961;154:939–48.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Todani T, Tabuchi K, Tanaka S. Intestinal atresia due to intrauterine intussusception: analysis of 24 cases in Japan. J Pediatr Surg. 1975;10(4):445–51.CrossRefPubMedGoogle Scholar
  40. 40.
    Graham JM-P, Marin-Padilla M, Hoefnagel D. Jejunal Atresia Associated with Cafergot® Ingestion During Pregnancy. Clin Pediatr. 1983;22(3):226–8.CrossRefGoogle Scholar
  41. 41.
    Kaga Y. Intestinal atresia in fetal dogs produced by localised ligation of mesenteric vessels. J Pediatr Surg. 1975;10:949.CrossRefGoogle Scholar
  42. 42.
    Moutsouris C. The “solid stage” and congenital intestinal atresia. J Pediatr Surg. 1966;1(5):446–50.CrossRefPubMedGoogle Scholar
  43. 43.
    Patricolo M, Noia G, Rossi L, Zangari A, Pomini F, Catesini C, Filippetti R, Galli T, Iacobelli BD, Capuano LG, Romano D, Mancuso S, Rivosecchi M. An experimental animal model of intestinal obstruction to simulate in utero therapy for jejunoileal atresia. Fetal Diagn Ther. 1998;13(5):298–301.CrossRefPubMedGoogle Scholar
  44. 44.
    de Chadarevian JP, et al. Terminal ileal atresia, total colonic aganglionosis, and thrombophilia. Pediatr Dev Pathol. 2009;12(5):394–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Gluer S. Intestinal Atresia Following Intraamniotic Use of Dyes. European Journal of Pediatric Surgery: Official Journal of Austrian Association of Pediatric Surgery. Z Kinderchir. 1995;5(4):240–2.Google Scholar
  46. 46.
    Yanagihara J, Nakamura J, Shimotake T, Deguchi E, Iwai N. An Association of Multiple Intestinal Atresia and Biliary Atresia: A Case Reportb. European Journal of Pediatric Surgery: Official Journal of Austrian Association of Pediatric Surgery. Z Kinderchir. 1995;5(6):372–4.Google Scholar
  47. 47.
    Johnson SM, Meyers RL. Inherited thrombophilia: a possible cause of in utero vascular thrombosis in children with intestinal atresia. J Pediatr Surg. 2001;36(8):1146–9.CrossRefPubMedGoogle Scholar
  48. 48.
    Mishalany HG, Najjar FB. Familial jejunal atresia: three cases in one family. J Pediatr. 1968;73(5):753–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Nichol PF, Reeder A, Botham R. Humans, mice, and mechanisms of intestinal atresias: a window into understanding early intestinal development. J Gastrointest Surg. 2011;15(4):694–700.CrossRefPubMedGoogle Scholar
  50. 50.
    Blyth H, Dickson JA. Apple peel syndrome (congenital intestinal atresia): a family study of seven index patients. J Med Genet. 1969;6(3):275–7.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Guttman FM, et al. Multiple atresias and a new syndrome of hereditary multiple atresias involving the gastrointestinal tract from stomach to rectum. J Pediatr Surg. 1973;8(5):633–40.CrossRefPubMedGoogle Scholar
  52. 52.
    Kimble R. Jejuno-ileal atresia, An inherited condition? Pediatr Surg Int. 1995;10:400.Google Scholar
  53. 53.
    Puri P, Fujimoto T. New observations on the pathogenesis of multiple intestinal atresias. J Pediatr Surg. 1988;23(3):221–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Shorter NA, Georges A, Perenyi A, Garrow E. A proposed classification system for familial intestinal atresia and its relevance to the understanding of the etiology of jejunoileal atresia. J Pediatr Surg. 2006;41(11):1822–5.CrossRefPubMedGoogle Scholar
  55. 55.
    Herman TEA, Mc Alister WH. Familial type 1 jejunal atresias and renal dysplasi. Pediatr Radiol. 1995;25(4):272–4.CrossRefPubMedGoogle Scholar
  56. 56.
    Baglaj M, Carachi R, Lawther S. Multiple atresia of the small intestine: A 20 year review. Eur J Pediatr Surg. 2008;18(1):13–8.CrossRefPubMedGoogle Scholar
  57. 57.
    Bass J. Pyloric atresia associated with multiple intestinal atresias and immune difficiency. J Pediatr Surg. 2002;37(6):941–2.CrossRefPubMedGoogle Scholar
  58. 58.
    Cole C, Freitas A, Clifton MS, Durham MM. Hereditary multiple intestinal atresias: 2 new cases and review of the literature. J Pediatr Surg. 2010;45(4):E21–4.CrossRefPubMedGoogle Scholar
  59. 59.
    Walker MW, Lovell MA, Kelly TE, Golden W, Saulsbury FT. Multiple areas of intestinal atresia associated with immunodeficiency and posttransfusion graft-versus-host disease. J Pediatr. 1993;123(1):93–5.CrossRefPubMedGoogle Scholar
  60. 60.
    Roberts HE, Cragan JD, Cono J, Khoury MJ, Weatherly MR, Moore CA. Increased frequency of cystic fibrosis among infants with jejunoileal atresia. Am J Med Genet. 1998;78(5):446–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Gaillard D, Bouvier R, Scheiner C, Nessmann C, Delezoide AL, Dechelotte P, Leheup B, Cordier MP, Carles D, Lallemand A. Meconium ileus and intestinal atresia in fetuses and neonates. Pediatr Pathol Lab Med. 1996;16(1):25–40.CrossRefPubMedGoogle Scholar
  62. 62.
    Wax JR, Hamilton T, Cartin A, Dudley J, Pinette MG, Blackstone J. Congenital jejunal and ileal atresia: natural prenatal sonographic history and association with neonatal outcome. J Pediatr Surg. 2009;44(1):71–4.CrossRefGoogle Scholar
  63. 63.
    Ruiz MJ, Thatch KA, Fisher JC, Simpson LL, Cowles RA. Neonatal outcomes associated with intestinal abnormalities diagnosed by fetal ultrasound. Fetal Diagn Ther. 1998;13(5):298–301.CrossRefGoogle Scholar
  64. 64.
    Tibboel D, Molenaar JC, Van Nie CJ. New perspectives in fetal surgery: the chicken embryo. J Pediatr Surg. 1979;14(4):438–40.CrossRefPubMedGoogle Scholar
  65. 65.
    Lopez de Torre B, Tovar JA, Uriarte S, Aldazabal P. The nutrition of the fetus with intestinal atresia: studies in the chick embryo model. J Pediatr Surg. 1992;27(10):1325–8.CrossRefPubMedGoogle Scholar
  66. 66.
    Tam PK, Nicholls G. Implications of antenatal diagnosis of small-intestinal atresia in the 1990s. Pediatr Surg Int. 1999;15(7):486–7.CrossRefPubMedGoogle Scholar
  67. 67.
    Tongsong T, Chanprapaph P. Triple bubble sign: a marker of proximal jejunal atresia. Int J Gynecol Obstet. 2000;68(2):149–50.CrossRefGoogle Scholar
  68. 68.
    Touloukian RJ. Intestinal atresia. Clin Perinatol. 1978;5(1):3–18.CrossRefPubMedGoogle Scholar
  69. 69.
    Touloukian RJ. Diagnosis and treatment of jejunoileal atresia. World J Surg. 1993;17(3):310–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Banieghbal B, Beale PG. Minimal access approach to jejunal atresia. J Pediatr Surg. 2007;42(8):1362–4.CrossRefPubMedGoogle Scholar
  71. 71.
    Lima M, et al. Evolution of the surgical management of bowel atresia in newborn: laparoscopically assisted treatment. Pediatr Med Chir. 2009;31(5):215–9.PubMedGoogle Scholar
  72. 72.
    Yamataka A, et al. Laparoscopy-assisted surgery for prenatally diagnosed small bowel atresia: simple, safe, and virtually scar free. J Pediatr Surg. 2004;39(12):1815–8.CrossRefPubMedGoogle Scholar
  73. 73.
    St. Peter SD, Little DC, Barsness KA, Copeland DR, Calkins CM, Yoder S, Rothenberg SS, Islam S, Tsao K, Ostlie DJ. Should We Be Concerned About Jejunoileal Atresia During Repair of Duodenal Atresia? J Laparoendosc Adv Surg Tech. 2010;20(9):773–5.CrossRefGoogle Scholar
  74. 74.
    Doolin EJ, H.S. Ormsbee, and J.L. Hill, Motility abnormality in intestinal atresia. J Pediatr Surg. 1987;22(4):320–4.CrossRefPubMedGoogle Scholar
  75. 75.
    Masumoto K, et al. Abnormalities of enteric neurons, intestinal pacemaker cells, and smooth muscle in human intestinal atresia. J Pediatr Surg. 1999;34(10):1463–8.CrossRefPubMedGoogle Scholar
  76. 76.
    Ozguner IF, Savas C, Ozguner M, Candir O. Intestinal atresia with segmental musculature and neural defect. J Pediat Surg. 2005;40(8):1232–7.CrossRefPubMedGoogle Scholar
  77. 77.
    Millar AJ, Rode H, Cywes S. A method of derotation and duodeno-jejunostomy for high jejunal atresia. J Pediatr Surg. 2001;36(5):833–4.CrossRefPubMedGoogle Scholar
  78. 78.
    Yamataka A, Koga H, Shimotakahara A, Kobayashi H, Lane GJ, Miyano T. Novel procedures for enhancing high jejunal atresia repair: bilateral side-plication and plication before anastomosis. Pediatr Surg Int. 2005;21(11):907–10.CrossRefPubMedGoogle Scholar
  79. 79.
    Cowles RA, et al. Serial transverse enteroplasty in a newborn patient. J Pediatr Gastroenterol Nutr. 2007;45(2):257–60.CrossRefPubMedGoogle Scholar
  80. 80.
    Luo CC, Ming YC, Chao HC, Chu SM. Duodenal Derotation and Extent Tapering Jejunoplasty as Primary Repair for Neonates With High Jejunal Atresia. Pediat Neonatol. 2010;51(5):269–72.CrossRefGoogle Scholar
  81. 81.
    Takahashi A, Suzuki N, Ikeda H, Kuroiwa M, Tomomasa T, Tsuchida Y, Kuwano H. Results of bowel plication in addition to primary anastomosis in patients with jejunal atres. J Pediatr Surg. 2001;36(12):1752–6.CrossRefPubMedGoogle Scholar
  82. 82.
    Kling K, et al. A novel technique for correction of intestinal atresia at the ligament of Treitz. J Pediatr Surg. 2000;35(2):353–5. discussion 356.CrossRefPubMedGoogle Scholar
  83. 83.
    Dewan PA, Guiney EJ. Duodenoplasty in the management of duodenal atresia. Pediatr Surg Int. 1990;5(4):253–4.CrossRefGoogle Scholar
  84. 84.
    Chaet MS, Warner BW, Sheldon CA. Management of multiple jejunoileal atresias with an intraluminal SILASTIC stent. J Pediatr Surg. 1994;29(12):1604–6.CrossRefPubMedGoogle Scholar
  85. 85.
    Federici S, Domenichelli V, Antonellini C, Dòmini R. Multiple intestinal atresia with apple peel syndrome: successful treatment by five end-to-end anastomoses, jejunostomy, and transanastomotic silicone stent. Pediatr Surg. 2003;38(8):1250–2.CrossRefGoogle Scholar
  86. 86.
    Honzumi M, Okuda A, Suzuki H. Duodenal motility after tapering duodenoplasty for high jejunal and multiple intestinal atresia. Pediatr Surg Int. 1993;8(2):116–8.CrossRefGoogle Scholar
  87. 87.
    Smith MB, Smith L, Wells W, Shapira E, Hendrickson M, Moynihan PC. Concurrent jejunal atresia with “apple peel” deformity in premature twins. Pediatr Surg Int. 1991;6(6):425–8.CrossRefGoogle Scholar
  88. 88.
    Yardley I, Khalil B, Minford J, Morabito A. Multiple jejunoileal atresia and colonic atresia managed by multiple primary anastomosis with a single gastroperineal transanastomotic tube without stomas. J Pediatr Surg. 2008;43(11):45–6.CrossRefGoogle Scholar
  89. 89.
    Dutta S. The STEP procedure: defining its role in the management of pediatric short bowel syndrome. J Pediatr Gastroenterol Nutr. 2007;45(2):174–5.CrossRefPubMedGoogle Scholar
  90. 90.
    Ehrlich PF, Mychaliska GB, Teitelbaum DH. The 2 STEP: an approach to repeating a serial transverse enteroplasty. J Pediatr Surg. 2007;42(5):819–22.CrossRefPubMedGoogle Scholar
  91. 91.
    Morikawa N, Kuroda T, Kitano Y, Tanaka H, Takayasu H, Fujino A, Shibata Y, Tanemura H, Muto M, Honna T. Repeat STEP procedure to establish enteral nutrition in an infant with short bowel syndrome. Pediatr Surg Int. 2009;25(11):1007–11.CrossRefPubMedGoogle Scholar
  92. 92.
    Wales PW, Dutta S. Serial transverse enteroplasty as primary therapy for neonates with proximal jejunal atresia. J Pediatr Surg. 2005;40(3):E31–4.CrossRefPubMedGoogle Scholar
  93. 93.
    Rehbein F. The double tube technique for the treatment of meconium ileus and small bowel atresia. J Pediatr Surg. 1968;3:723.CrossRefGoogle Scholar
  94. 94.
    Rosenmann J. A reappraisal of the Mikulicz enterostomy in infants and children. Surgery. 1982;91:34.Google Scholar
  95. 95.
    van Hoorn WA, Hazebroek FW, Molenaar JC. Gastroschisis associated with atresia—a plea for delay in resection. Z Kinderchir. 1985;40(6):368–70.PubMedGoogle Scholar
  96. 96.
    Phillips JD, Raval M, Redden C, Weiner TM. Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. J Pediatr Surg. 2008;43(12):2208–12.CrossRefPubMedGoogle Scholar
  97. 97.
    Piper HG, Alesbury J, Waterford SD, Zurakowski D, Jaksic T. Intestinal atresias: factors affecting clinical outcomes. J Pediat Surg. 2008;43(7):1244–8.CrossRefPubMedGoogle Scholar
  98. 98.
    Ellaway C, Beasley SW. Bezoar formation and malabsorption secondary to persistent dilatation and dysmotility of the duodenum after repair of proximal jejunal atresia. Pediatr Surg Int. 1997;12(2–3):190–1.CrossRefPubMedGoogle Scholar
  99. 99.
    Houben C, et al. Closing gastroschisis: diagnosis, management, and outcomes. J Pediatr Surg. 2009;44(2):343–7.CrossRefPubMedGoogle Scholar
  100. 100.
    Hess RA, et al. Survival outcomes of pediatric intestinal failure patients: analysis of factors contributing to improved survival over the past two decades. J Surg Res. 2011;170(1):27–31.CrossRefPubMedGoogle Scholar
  101. 101.
    Nehra D, Fallon EM, Puder M. The prevention and treatment of intestinal failure-associated liver disease in neonates and children. Surg Clin North Am. 2011;91(3):543–63.CrossRefPubMedGoogle Scholar
  102. 102.
    Grosfeld JL, O’Neill J, Coran A. Jejunoileal atresia and stenosis. Paediatr Surg. 2006;2:6.Google Scholar
  103. 103.
    Thompson JS, et al. Current management of the short bowel syndrome. Surg Clin North Am. 2011;91(3):493–510.CrossRefPubMedGoogle Scholar
  104. 104.
    Karpelowsky JS, et al. Outcomes of human immunodeficiency virus-infected and -exposed children undergoing surgery—a prospective study. J Pediatr Surg. 2009;44(4):681–7.CrossRefPubMedGoogle Scholar
  105. 105.
    Shakya VC, Agrawal C, Shrestha P, Poudel P, Khaniya S, Adhikary S. Management of jejunoileal atresias: an experience at eastern Nepal. BMC Surg. 2010;26(10):35.CrossRefGoogle Scholar
  106. 106.
    Danismend EN, Frank JD, Brown S. Morbidity and Mortality in Small Bowel Atresia. Jejuno-ileal Atresia. European Journal of Pediatric Surgery: Official Journal of Austrian Association of Pediatric Surgery. Z Kinderchir. 1987;42(1):17–8.PubMedGoogle Scholar
  107. 107.
    Dicken BJ, et al. Medical management of motility disorders in patients with intestinal failure: a focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia. J Pediatr Surg. 2011;46(8):1618–30.CrossRefPubMedGoogle Scholar
  108. 108.
    Kelly DA. Preventing parenteral nutrition liver disease. Early Hum Dev. 2011;86(11):683–7.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Emeritus Professor of Paediatric SurgeryUniversity of Cape Town, Red Cross War Memorial Children’s HospitalCape TownSouth Africa
  2. 2.Charles F.M. Saint Professor of Paediatric Surgery, Division of Paediatric SurgeryRed Cross War Memorial Children’s Hospital, University of Cape TownCape TownSouth Africa

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