Multiple gastrointestinal atresias, with intraluminal calcifications and cystic dilatation of bile ducts: a newly recognized entity resemblin "a string of pearls"

The siblings reported here represent a new and complex congential anomaly. A genetic basis is strongly suggested. The natural preparation of closed loop duodenal obstruction and cystic dilatation of the bile ducts is a unique finding. The hallmark of this new entity--intraluminal calcifications strung out through small and large intestine like pearls--is a striking radiographic feature and, in the proper clinical setting, pathognomonic. This entity has been uniformly lethal. Once the diagnosis is confirmed, no known therapy is useful.

The pathogenesis of intestinal atresia

The records of 28 patients with duodenal and 31 with jejunoileal intestinal atresia or stenosis were studied. Vomiting and abdominal distention were the most prominent symptoms; an unusual colon may be present in jejunal as well as ileal obstruction and is not pathognomonic for ileal obstruction. Intestinal atresia is associated with a high incidence of preterm babies but with a low incidence of intrauterine growth retardation. Fifty-three infants were operated upon; the overall survival rate was 79 per cent. The high percentage of mortality in duodenal obstruction is due to associated malformations. Theories of the pathogenesis of intestinal atresia do not seem to fit current clinical and experimental evidence in all patients. Possibly, different factors play a role in separate situations.

Pyloro-duodenal atresia. A report of three families with several similarly affected children

Seven patients born with pyloro-duodenal atresia are reported, one had an additional atresia of the small and large bowel, and another had a pneumoperitoneum probably secondary to rupture of the stomach. All patients had the same radiological findings and had no air distal to the pylorus. Consanguinity was elicited in four and a familial incidence of an identical malformation in siblings in six. 6 of the 7 patients were operated on and 4 are living and well 6 months to 5 years later. This report raises the total number of published cases of pyloro-duodenal atresia to 46, and provides further evidence for an autosomal recessive mode of inheritance.

Some congenital malformations necessitating emergency operations in the newborn period

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