The etiologic role of intrauterine volvulus and intussusception in jejunoileal atresia

Komuro, Hiroaki; Hori, Tetsuo; Amagai, Teruyoshi; Hirai, Misako; Yotsumoto, Katsumi; Urita, Yasuhisa; Gotoh, Chikashi; Kaneko, Michio

doi:10.1016/j.jpedsurg.2004.08.037

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Volume 39, Issue 12 , Pages 1812-1814, December 2004

The etiologic role of intrauterine volvulus and intussusception in jejunoileal atresia

Presented at the 37th Annual Meeting of the Pacific Association of Pediatric Surgeons, Seoul, Korea, May 16–20, 2004.

Hiroaki Komuro
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Address reprint requests to Hiroaki Komuro, MD, PhD, Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Ibaraki 305-8575, Japan
Tetsuo Hori
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Teruyoshi Amagai
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Misako Hirai
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Katsumi Yotsumoto
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Yasuhisa Urita
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Chikashi Gotoh
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Michio Kaneko
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

Abstract

Purpose

Although intussusception has been reported as quite a rare cause of jejunoileal atresia (JIA), pediatric surgeons have noted the frequent presence of intussusception as well as volvulus at surgery. The aim of this study was to investigate the contribution of intrauterine intussusception and volvulus to the development of JIA.

Methods

In 48 newborns (24 boys and 24 girls) treated for JIA at our hospital between 1978 and 2004, the operative and pathologic findings were reviewed.

Results

Intussusception was responsible for gap and cord type atresia in 12 cases (25%). The cord showed an atrophic intestinal lumen in 2 cases. Volvulus was observed in 13 cases. Volvulus and intussusception were simultaneously noted in 1 case. This suggested that intussusception was the cause of the atresia, whereas volvulus was a secondary event. Neither intussusception nor volvulus was observed in high jejunal, apple peel, or multiple atresia.

Conclusions

Intrauterine volvulus and intussusception were commonly observed in single mid- and low JIA. Thus, intrauterine intussusception may be a common cause of gap and cord type JIA. Volvulus may not only cause JIA but also result from anatomic changes after the development of JIA in some cases.

Keywords: Jejunoileal atresia, vascular disruption, intrauterine, volvulus, intussusception