Management of intestinal atresia: Challenges and outcomes in a resource-scarce region

Intestinal atresia is a common cause of intestinal obstruction in the newborn, associated with poor outcomes in many developing countries due to clinical sequelae of the lesion. Although outcomes have improved in many centers, the management requires facilities that are in short supply in developing countries. Here we report on five-year outcomes, challenges, and experiences gained with the management of intestinal atresia in a resource-scarce region and compare results with the preceding five years. A prospective study based on children diagnosed with intestinal atresia between July 2003 and June 2008 at the University of Benin Teaching Hospital, Benin City, Nigeria. Results were documented on a structured form and analyzed. The outcomes were compared between group A, comprising the preceding five years (July 1999-June 2003), and group B, comprising the present study group (July 2003-June 2008). Forty-three babies aged between 2 and 32 days (mean 11 +/- 1.8 days), comprising 26 males and 17 females (ratio 1.5 : 1), were managed with intestinal atresia. Delayed presentation of these babies, which allowed fluid/electrolyte derangement, inanition, and established overwhelming resistant sepsis, as well as a lack of facilities, were major challenges resulting in poor outcomes (P < 0.0001). Aggressive resuscitation, resection of dilated proximal bowel segment allowing early commencement of oral feeds, enteroplasty, long use of broad spectrum antibiotics, improvised facilities to supply heat, and dedicated staff led to improved results. The number of survivors increased from 25% in group A to 75% in group B. This 75% survival rate could be increased further if there was provision of adequate facilities, especially total parenteral nutrition, and health awareness programs that result in early presentation.