Atresias

Atresia refers to the absence or closure of a normal body lumen or duct, resulting in nonpatency. The plural atresias is used for multiple sites. Most are congenital malformations arising during embryogenesis, though acquired closures can occur after birth due to scar or vascular injury. While they can involve any tubular tract, they most often affect the gastrointestinal and biliary systems.

Common types include esophageal atresia (often with a tracheoesophageal fistula), intestinal atresias (duodenal, jejunal, ileal, or colonic), anorectal atresia, and biliary atresia (blocked or absent bile ducts). Pathogenesis varies: failure of recanalization in the gut, or vascular disruption in some segments.

Clinical features are location-dependent. Neonates with esophageal atresia present with drooling and choking on feeds; those with intestinal atresias show bilious vomiting and abdominal distension; anorectal atresia causes an absent anal opening. Prenatal signs may include polyhydramnios.

Diagnosis combines physical findings with imaging and laboratory tests. Postnatal evaluation uses radiographs, ultrasound, and endoscopy as appropriate; biliary atresia presents with neonatal cholestasis.

Management is surgical and site-specific. Esophageal atresia/TEF repair, resection with anastomosis for intestinal atresias, and corrective procedures for anorectal malformations are typical. Biliary atresia is treated with Kasai portoenterostomy, with liver transplantation considered if drainage remains poor.

Prognosis depends on the specific site and associated anomalies, as well as the timeliness and success of surgical intervention. Multidisciplinary care improves outcomes.