OJPed  Vol.5 No.4 , December 2015
“Inverse Type” Apple-Peel Syndrome Is Associated with Type III Colonic Atresia in a Neonate with Gastroschisis—A “New” Subtype of Colonic Atresia
Abstract: The colon is an unusual site of intestinal atresia. Colonic atresia is subdivided into three phenotypes. Type III is the most common phenotype, where the proximal and distal blind sacs are not connected. Here, we report on the presence of colonic atresia with an “inverse apple-peel” appearance in a neonate with gastroschisis. The lack of mesenteric fixation of the entire small intestine, including the proximal colon, and the twisting around the vascular axis of the superior mesenteric artery led to intrauterine volvulus and hemorrhagic infarction of the ileocolic bowel at 34 weeks of gestation. According to the current nomenclature for small bowel atresia, we introduce type IIIB into the current colonic atresia classification. The occurrence of type IIIB has been mentioned in the literature, but no single cases have been reported until now. Patients with this type of atresia are predisposed to the loss of the ileocecal region.
Cite this paper: Tröbs, R. , Bahr, M. , Schulze, R. , Neid, M. , Pielemeier, W. and Roll, C. (2015) “Inverse Type” Apple-Peel Syndrome Is Associated with Type III Colonic Atresia in a Neonate with Gastroschisis—A “New” Subtype of Colonic Atresia. Open Journal of Pediatrics, 5, 348-352. doi: 10.4236/ojped.2015.54052.

[1]   Aguayo, P. and Ostlie, D.J. (2010) Duodenal and Intestinal Atresia and Stenosis. In: Holcomb III, G.W. and Murphy, J.P., Eds., Ashcraft’s Pediatric Surgery, 5th Edition, Saunders, Elsevier, Philadelphia, 413-415.

[2]   Baglaj, M., Carachi, R. and MacCormack, B. (2010) Colonic Atresia: A Clinicopathological Insight into Its Etiology. European Journal of Pediatric Surgery, 20, 102-105.

[3]   von Schweinitz, D. (2013) Angeborene fehlbildungen und obstruktionen des dünndarms. In: von Schweinitz, D. and Ure, B., Eds., Kinderchirurgie, 2nd Edition, Springer, Berlin, Heidelberg, 344-345.

[4]   Wester, T. (2011) Colonic and Rectal Atresias. In: Puri, P., Ed., Newborn Surgery, 3rd Edition, Hodder Arnold, London, 505-511.

[5]   Grosfeld, J., Ballantine, T. and Shoemaker, R. (1979) Operative Management of Intestinal Atresia and Stenosis Based on Pathological Findings. Journal of Pediatric Surgery, 14, 595-599.

[6]   Veccia, L.K.D., Grosfeld, J.L., West, K.W., Rescorla, F.J., Scherer, L.R. and Engum, S.A. (1998) Intestinal Atresia and Stenosis. A 25-Year Experience with 277 Cases. Archives of Surgery, 133, 490-497.

[7]   Santulli, T.V. and Blanc, W.A. (1961) Congenital Atresia of the Intestine: Pathogenesis and Treatment. Annals of Surgery, 154, 939-948.

[8]   Holmes, L.B. (2012) Common Malformations. Oxford University Press, Oxford, New York, Auckland, 37-44, 109-115.

[9]   Bergholz, R., Boettcher, M., Reinshagen, K. and Wenke, K. (2014) Complex Gastroschisis Is a Different Entity to Simple Gastroschisis Affecting Morbidity and Mortality. A Systematic Review and Meta-Analysis. Journal of Pediatric Surgery, 49, 1527-1532.

[10]   Fleet, M.S. and de la Hunt, M.N. (2000) Intestinal Atresia with Gastroschisis. Journal of Pediatric Surgery, 35, 1323-1325.

[11]   Lynn, H.B. and Espinas, E.E. (1959) Intestinal Atresia. An Attempt to Relate Location to Embryologic Process. Archives of Surgery, 79, 357-361.

[12]   Menardi, G. (1987) Congenital Colonic Atresias. European Journal of Pediatric Surgery, 42, 31-35.

[13]   Snyder, C.L., Miller, K.A., Sharp, R.J., Murphy, J.P., Andrews, W.A., Holcomb III, G.W., Gittes, G.K. and Ashcraft, K.W. (2001) Management of Intestinal Atresia in Patients with Gastroschisis. Journal of Pediatric Surgery, 36, 1542-1545.

[14]   Louw, J. (1964) Investigation into the Etiology of Congenital Atresia of the Colon. Diseases of the Colon & Rectum, 7, 741-748.

[15]   Carnaghan, H., Pereira, S., James, C.P., Charlesworth, P.B., Ghionzoli, M., Mohamed, E., Cross, K.M.K., Kiely, E., Patel, S., Desai, A., Nicolaides, K., Curry, J.I., Ade-Ajayi, N., de Coppi, P., Davenport, M., David, A.L., Pierro, A. and Eaton, S. (2014) Is Early Delivery Beneficial in Gastroschisis? Journal of Pediatric Surgery, 49, 928-933.

[16]   Bucher, B.T., Mazotas, I.G., Warner, B.W. and Saito, J.M. (2012) Effect of Time to Surgical Evaluation on the Outcomes of Infants with Gastroschisis. Journal of Pediatric Surgery, 47, 1105-1110.