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      L’Atrésie colique: à propos de deux cas Translated title: Colonic atresia: report of two cases

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          Abstract

          L’atrésie colique est la moins fréquente des atrésies de l’appareil digestif. Le trouble de vascularisation anténatal est l’hypothèse étiologique la plus communément admise pour expliquer les formes complètes. Cette anomalie peut être isolée ou faire partie d’un syndrome poly malformatif. Nous rapportons deux cas d’atrésie du colon: le premier admis dans un tableau d’occlusion néonatale basse, épreuve à la sonde négative. L’exploration chirurgicale a objectivé une atrésie colique type I. le patient a bénéficié d’une colostomie première puis d’une anastomose termino-terminale. Avec des suites opératoires simples. Le deuxième patient a été admis dans un tableau d’occlusion néonatale haute. L’atrésie colique était de découverte fortuite en per-opératoire, associée à une atrésie grêlique. Le patient a bénéficié d’une double stomie, mais les suites opératoires ont été marquées par le décès dans un tableau de choc septique. A la lumière des ces deux observations et après une revue de la littérature; Nous soulignons la rareté de la pathologie et la difficulté de prise en charge surtout en cas de retard diagnostic.

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          Most cited references 12

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          Intestinal atresia and stenosis: analysis of survival in 120 cases.

          This report reviews the clinical presentation, operative management, and survival in 120 infants with intestinal atresia and stenosis treated from 1972 to 1984. Duodenal atresia occurred in 39 neonates and duodenal stenosis in 19. Thirty-two infants had severe associated anomalies. Operative management included duodenoduodenostomy in 47 infants, duodenotomy and web excision in four, and duodenojejunostomy in seven. Jejunoileal atresia occurred in 49 infants and stenosis in three. Six infants had cystic fibrosis and nine had gastroschisis. Operative therapy included wide proximal resection and end-to-end anastomosis in 18 infants, minimal resection with antimesenteric tapering enteroplasty and anastomosis in 14 neonates, and resection with temporary enterostomies in 20 infants. Twenty-nine infants (56%) required total parenteral nutrition. Colon atresia occurred in 11 infants and stenosis in one. Initial end-colostomy with subsequent resection and anastomosis was performed in 11 infants while one underwent a primary resection. The survival rate was 91% for duodenal defects, 87% for jejunoileal cases, and 100% for colonic anomalies. Death is currently caused by severe associated anomalies in infants with duodenal atresia and sepsis and total parenteral nutrition-related cholestasis with progressive liver failure in instances of jejunoileal atresia.
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            Atresia of the colon.

            Colonic atresia (CA) is one of the rarest causes of neonatal intestinal obstructions, and no large series can be reported. Therefore, we did perform a retrospective clinical trial to delineate our CA cases and carry out a literature survey. We reviewed the charts of CA cases treated in our center between 1992 and 2002. We aimed to collect all reported cases in Medline, and personal communications with the authors of published series were used to reach the missing data. The chart review revealed 9 newborns with CA treated in our center (6 cases of type III, 2 cases of type II, and 1 case of type IV). These accounted for 3.7% of all gastrointestinal atresias managed in our center. Of the CA cases, 3 were isolated and 6 had at least one or more associated congenital anomalies. The preferred surgical technique at the initial treatment of CA was performing a proximal stoma and distal mucous fistula in an average of postnatal 59.4 hours. The literature survey enabled us to reach 224 cases of CA, including our cases. Because of the low incidence of CA, delay in diagnosis and treatment may occur. The mortality is statistically higher when the surgical management is performed after 72 hours of age. However, the prognosis of CA is satisfactory if diagnosis and surgical management could be made promptly and properly.
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              MRI of fetal GI tract abnormalities.

              We describe the magnetic resonance (MR) patterns of a variety of fetal gastrointestinal (GI) abnormalities. Thirty-two fetuses between 23 and 38 weeks' gestation with abnormal appearance of the GI tract by ultrasound underwent MR imaging with T1- and T2-weighted sequences. The MR aspect of intestinal atresia (duodenal atresia, one case; small bowel atresia, nine cases) included dilatation of the bowel loops, accurate assessment of the normal bowel distal to the atresia (except in the patient with multiple atresia and apple-peel syndrome), and micro-rectum with decreased T1 signal (except in the patient with duodenal atresia). Megacystis-microcolon-intestinal hypoperistalsis syndrome (one case) was indicated by an abnormal signal of the entire bowel and an abnormal pattern for the urinary tract. Meconium pseudocysts (two cases) were easily differentiated from enteric cysts (two cases). High anorectal malformations with (two cases) or without (one case) urinary fistula and cloacal malformation (one case) are described and MR findings are discussed. The capability of MR imaging to demonstrate the normal bowel with intraperitoneal anomalies (e.g., congenital diaphragmatic hernia, and sacrococcygeal teratoma) is emphasized. MR imaging is informative in the diagnosis of GI tract abnormalities, especially the severe malformations, with much more accuracy than sonography.
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                Author and article information

                Journal
                Pan Afr Med J
                pamj
                The Pan African Medical Journal
                African Field Epidemiology Network
                1937-8688
                1937-8688
                2010
                04 November 2010
                : 7
                Affiliations
                [1 ]Service de Chirurgie Pédiatrique, CHU Hassan II, Fès, Maroc
                [2 ]Service d’Anesthésie Réanimation, CHU Hassan II, Fès, Maroc
                Author notes
                [& ]Corresponding author: Shimi Abdelkarim, Service d’Anesthésie réanimation, CHU Hassan II, 30000, Fès, Maroc
                3172625
                21954407
                Karima Atarraf et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Life Sciences
                Medicine

                Medicine

                colon, maroc, chirurgie, atrésie, appareil digestif

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