Ileal Atresia Rapid Fire: Update Course 2015

In apple peel ileal atresia with ischemic-appearing distal ileum, anastomosis should not be performed if there is concern about vascularization of the distal bowel.

Apple peel ileal atresia cases typically have relatively short gut, and the apple-peeled bowel is not always healthy.

If bowel is ischemic (not necrotic), waiting until the next day to see if it pinks up is a reasonable option.

Plication of dilated proximal bowel in ileal atresia is often helpful.

STEP procedure can be performed on proximal dilated intestine in scenarios with limited distal small bowel and concern for short bowel syndrome.

Bianchi procedure produces two equal chambers without blind-ending outpouchings, making it preferable to STEP when there is adequate blood supply.

STEP should not be performed in the neonatal period; instead, primary anastomosis with plication is preferred, with bowel lengthening deferred to a later time.

Plications usually unravel with time, allowing the bowel to be used later for bowel lengthening procedures.

Bianchi can be performed first and then STEP later if needed, whereas once STEP is performed, re-STEP is possible but lengthening ability is altered.

In cases of very dilated dysfunctional bowel that becomes a cesspool of bacterial stasis, some intervention is sometimes necessary.

In newborns with questionable short gut, tapering should be avoided to save bowel for potential lengthening later.

If a patient has an extensive amount of bowel with a dilated segment, tapering is very reasonable.