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Few gas filled loops beyond duodenum indicates jejunal atresia. Many gas filled loops (requires 24 hours) indicates some form of low intestinal obstruction. Parents may not call before the infant gets into trouble with enterocolitis. Suction biopsy of the rectum is probably indicated in all cases of so called meconium plug syndrome or small left colon syndrome.

Meconium ileus (an unfortunate misnomer)- obstruction of the distal small intestine by thick undigested meconium. Meconium plug syndrome - obstruction of colon by a plug of meconium. Whether or not a suction biopsy of the rectum is done before the infant goes home depends on the clinical setting but the safe course of action is to do the rectal biopsy before discharge.

Complications after surgery: anastomotic leak, stricture, gastroesophageal reflux, tracheomalacia and recurrent TEF.

Increase survival is associated with improvements in perioperative care, meticulous surgical technique and aggressive treatment of associated anomalies.

If there is any doubt about the absence of ganglion cells in the suction biopsy, a full thickness biopsy of the rectum (a difficult technical procedure requiring a general anesthetic) can be done to settle the issue.

Another important point to remember is that duodenal atresia is a different disease from jejunal or ileal atresia in terms of their cause.

Hypothyroidism in the first two to three months of life can mimic Hirschsprung's disease in all aspects except for a normal rectal biopsy.

If ganglion cells are present, Hirschsprung's disease is ruled out and the infant probably has a non-surgical diagnosis.

In all of these clinical situations, a suction biopsy of the rectum is an excellent screening procedure.

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Other urinary tract anomalies which may be associated with severe hydronephrosis. This is usually not difficult in instances of complete high small bowel obstruction or when plain films of the abdomen show calcification and/or a distal small bowel obstruction with the contrast enema showing a microcolon or a definite malrotation of the colon (cecum in upper mid-abdomen or left upper quadrant).

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