IN-UTERO INTUSSUSCEPTION PRODUCING ILEAL ATRESIA AND MECONIUM PERITONITIS WITH AND WITHOUT FREE-AIR - REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

Two cases of intestinal atresia due to in utero intussusception are re ported. Meconium peritonitis occurred in both cases and in one free ai r in the peritoneal cavity was also found. Both were managed successfu lly by resection and end-to-end anastomosis. The intussusceptions were discovered on gross and microscopic examination of the distal ileal s egment. These two cases and 33 from the literature are reviewed to det ermine to the ileum and jejunum in all cases and involved the ileum in 77%. The atresia was Limited to the gap and fibrous-connecting-cord t ypes in all cases, with the gap type slightly more frequent (57%). In all but 1 of the 35 cases (97%), the intussusceptum was found in the s mall-bowel segment distal to the atresia; in only 2 were free air and calcium deposits identified at birth on X-ray studies of the abdomen. Prematurity was encountered in only 14% of the 35 cases, suggesting th at intussusceptum-induced mid,out atresia occurs late in pregnancy. Th e occurrence of two cases in 2 years in Torrance, California, and thre e cases in 3 years in Helsinki, Finland, suggest that this occurrence must be more frequent than the sparse incidence reported in the litera ture would indicate. It is suggested that careful gross and microscopi c examination of the small-bowel segment just distal to the atresia be carried out in all cases of jejunoileal atresia of gap or cord types to determine the true incidence and clinical nature of this type of in utero intussusception-induced jejunoileal atresia.