Prenatal ve Postnatal Dönemlerde Tanı Alan Konjenital Gastrointestinal Sistem Obstruksiyonlarının Retrospektif Olarak İncelenmesi
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Congenital obstruction of the gastrointestinal tract (GIT) organs such as esophagus, ileum, jejunum, colon, rectum and anus may have signs at the time of prenatal ultrasonography. The prenatal detection is influenced by several factors as the site of obstruction, degree of the lesion (partial or complete), occurrence of associated malformations and the gestational week at screening. We aimed to evaluate pre- and post-natally diagnosed GIT obstructions in our center. Our study is consisted of 34 prenatally and 22 postnatally diagnosed babies with GIT malformations. GIT obstructions were divided into 5 groups according to the level of obstruction (A. Esophagus, B. Stomach and proximal duodenum, C. Small intestine, D. Large intestine, E. Multiple obstructions). Prenatal detection rate was found to be 60.7% among all cases. Associated structural malformation and aneuploidy rates were 21.4% and 5.4%, respectively. Twelve neonates died within the first day after birth due to various reasons. The remaining 43 of 44 patients underwent surgery at different times according to their clinical conditions. The mean time between birth and surgery was 4.5 days (range, 1–56 days). There were 12 postoperative deaths due to various complications, and 1 patient died at an age of 2 years. Overall, 31 of 56 (55.4%) babies were alive during the follow-up period. The successful prenatal diagnosis rate was 57.2%, 85.8%, 75%, 25% and 80% in groups A to E, respectively. The median birth weight increased significantly in groups A to D (p=0.04). However, there was no difference between groups in terms of Apgar scores, associated abnormality rate, time to surgery, and number of operated babies. All of these findings demonstrate the importance of prenatal ultrasonography and prenatal detection performance for upper GIT abnormalities. In conclusion, the prenatal diagnosis of GIT malformations depends on multiple factors. Although there are some signs such as double bubble, polyhydramnios, enlarged bowel, and failure to visualize the stomach, early prenatal diagnosis is difficult and can be delayed after birth in some cases. On suspicion of GIT obstruction, clinicians should evaluate the fetal anatomy carefully and be aware of associated chromosomal abnormalities.