WOFAPS 2025 8th World Congress of Pediatric Surgery

Aziz Ahmed Chattha ¹, Nabila Talat ¹, Muhammad Zubair Shoukat ¹, Jamaal Butt ¹, Rija Khalid ²

¹ University of child health sciences, The Childrens Hospital, Lahore
² Shaukat Khanum Memorial Cancer Hospital, Lahore

Background:
Colorectal atresias are rare congenital anomalies (1.8-5% of intestinal atresias) that present significant surgical challenges, especially in resource-limited settings. This study aims to give insight into the incidence, anatomical distribution, surgical management strategies, outcomes, and association with Hirschsprung’s Disease (HD) in patients managed at our center over six years.

Methods:
A retrospective descriptive case series was conducted of patients diagnosed with colonic or rectal atresia from 2018 to 2024. Data were collected on type and location of atresia, surgical approach (primary vs staged), biopsy practices, outcomes, and follow-up status. Associations between procedure type and outcomes were analyzed using Chi-square tests.

Results:
Thirty-six patients were included (58.3% male). Rectal atresia accounted for 36.1% of cases, followed by Type I (22.2%), Type II (19.4%), and Type III (19.4%) colonic atresia. Sigmoid (33.3%) and ascending colon (27.8%) were the most common atretic sites. Only 3 patients (8.3%) underwent primary repair, while 91.7% received staged procedures. Definitive procedures were completed in 25% of patients. Mortality was 13.9% (5/36), all within colonic atresia patients. The surgical approach significantly affected outcomes (p=0.047), with primary repair associated with higher mortality (3/3 patients). Only 6 patients underwent rectal biopsy, with HD confirmed in 2 cases.

Conclusion:
Colorectal atresias require individualized surgical planning. Staged management appears safer, especially for colonic atresia, given the poor outcomes with primary repair. Rectal atresia had excellent prognosis, with no deaths. The low biopsy rate highlights a potential oversight in excluding Hirschsprung’s Disease. Our findings support routine rectal biopsy in all colorectal atresia cases to ensure appropriate management. Early recognition, a cautious staged approach, and attention to associated anomalies are key to improving outcomes in these complex patients.