Jejunoileal Atresia: A 5 Year Institutional Review of Surgical Outcomes, Prognostic Factors and the Impact of Delayed Presentation in a Resource-Limited Setting

Abstract

Introduction: Jejunoileal atresia (JIA) is a frequent cause of intestinal obstruction in the newborn and it occurs in 1-3 per 10,000 live births. The condition is caused by vascular accident in utero. The antenatal diagnosis is difficult even though prenatal imaging has improved. Neonates with JIA normally manifest within the first 24-48 hours of birth with biliary emesis and inability to empty meconium with or without abdominal distension. The gold standard is surgical resection of the atresia segment and end to end anastomosis. When neonates are in severe sepsis or in poor general state or in severe bowel distension, other surgical methods- stoma or a chimney procedure (e.g Santulli) can be used. Survival rates in developed countries are more than 90% due to early diagnosis, neo-natal intensive care advancements, pediatric anaesthesia expertise and access to total parenteral nutrition (TPN). Aims and Objectives: This paper seeks to carry out an institutional review based on cases of jejunoileal atresia that have been conducted over a period of 5 years basing on short term outcomes and survival influencing factors. Materials and Methods: A retrospective study was conducted on neonates admitted with jejunoileal atresia who were operated between January 2020 to December 2024. The data that was recorded include the demographics, clinical presentation, and preparation, surgical details and outcomes along with associated anomalies if any. Tο establish the significant predictors of survival, statistical analysis was done. Results: 33 neonates with jejunoileal atresia were operated with a male-female ratio of 1.36:1. 79% were low birth weight, and 64% were very low birth weight. The average age of presentation was around 9.5 days. Our study indicated the timing of presentation and birth weight as significant factors of survival. Even though the overall survival which was 72 % at the time of initial discharge had declined to 64% at least 6 months follow up, the switchover to Santulli ( chimney) procedure in the final 2 years yielded a survival of more than 90% Conclusions: Neonates with late presentation and low birth weight did poorly. High index of suspicion of intes-tinal obstruction in neonates who have biliary emesis is essential for early diagnosis. Survival might be enhanced by antenatal diagnosis by intervening in time. A chimney operation such as Santulli, which was found to have a higher survival rate than primary anastomosis in neonates of unfavorable general condition and massive luminal disparity, has turned out to be saviour in resource-limited tertiary centres.