Intestinal stenosis and atresia

A wide range of congenital anomalies may affect the whole gastrointestinal tract, from the esophagus to the rectum. High intestinal obstructions are those occurring proximal to the ileum, whereas low obstructions involve the distal ileum and colon and typically result in dilation of several bowel loops. These abnormalities are a significant cause of morbidity in children and, less frequently, in adults. Most of these congenital anomalies, especially those involving the small intestine, present with obstructive symptoms, while some of them with abdominal pain, vomiting, and gastrointestinal bleeding. Definitive therapy is surgical, and in some cases, it has to be performed urgently. Their diagnosis may require several imaging modalities in order to tailor the most appropriate treatment. Some of them, such as gastric or high intestinal obstruction, do not usually require further investigation; on the other hand, low obstructions require a barium enema study. US has become important for the evaluation of some of these abnormalities; it can help to differentiate a small bowel obstruction from a colonic obstruction. In addition, it may help to suggest possible anorectal malformations through dynamic procedures. A detailed anatomical investigation is crucial in tailoring the most appropriate surgical approach for each patient. For this reason MRI is essential because it well depicts the pelvic and perineal anatomy in order to evaluate the location and morphology of the anorectal malformation and to study the grade of development of the puborectalis and sphincteric musculature before the surgery.