ABSTRACT
The use of a transverse incision in the bowel proximal to the obstruction anastomosed to a longitudinal incision in the distal bowel, results in the classically described diamond-shaped anastomosis that tends to hold the anastomosis open. Treatment will depend on the intraoperative assessment of the entire bowel for multiple atresias versus a single affected portion. Abdominal radiographs will reveal dilated bowel loops, and contrast enema will reveal a large meconium plug and may result in the passage of this plug, followed by spontaneous stooling. In order to characterize fully the obstruction, a constrast enema should be obtained, which will reveal a small caliber microcolon. Approximately 13–17% of neonates born with cystic fibrosis are at risk of developing an obstruction due to the thick nature of meconium. Necrotic tissue should be debrided and any obstruction should be relieved during the course of the operation, with full awareness that the peritonitis may lead to friability of the tissue and problems with bleeding.
