The option is looking for associated anomalies (ECHO-cardio, abdominal and CNS US scans) and abdominal surgery. Microcolon is typical in intestinal atresias, anyway the meconium ileus is to be thought about as well

Thank you so much 

Does your question refers to the surgical decision making (i.e. Anastomosis vs. diversion) or to a protocol to follow with this type of patients?

Yes it's.. To do ileostomy or to do ileo colic anastmosis 

I see, on my experience it will all depend on the discrepancy among both ends. 

It is usually a very high discrepancy, so what I do in those cases is to divert the patient and wait some time until the patient is older. There are some anecdotal reports of using saline enemas to make the colon dilate over a given period of months, but no real proof whatsoever. 

I would advise to you to try to do an anastomosis if its feasible, whether you think its better a side-to-side or end-to-side one. If you think it would jeopardize patient's well being or the discrepancy between ileum and colon is too high, divert and wait.

I don't think these patients have a high index of associated malformations, but I wouldn't mind using non-invasive, non-radiation methods to find out. 

Dear Bruno thank you so much for your valuable experience 

Hello once more time,

another option would be TTES - T-tube enterostomy. You can control the healing process of anastomotic site, decompress dilated intestine and have an opportunity to check the GI tube in any doubt of its patency. If you are interested in really of what I am writing about, you can find my articles in the web.

I will thank you so much 

Hi Hisham. We avoid stomas for atresia if possible. If the patient has short bowel, tapering with an end: spatulated end anastomosis; otherwise resection to fair-size calibre if enough length of bowel to allow end: end  or end: spatulated end (up to 4:1 size ratio) primary anastomosis. If extremely short bowel and considering STEP or LILT procedure on dilated proximal bowel will still try to do primary end: side anastomosis in the interval rather than stoma, but motility problems in dilated bowel can cause problems with translocation and sepsis. We struggle with nutritional support for high output stomas due to limited resources.

I'm preferring primary anastmosis, but if the situations of the baby or the facilities are not feasible, a covering stoma will save the baby and take him for further repair.

Thank you so much, that exactly what I did 

In this situation I would resect the very dilated  ileal end and flush the colon with saline to check for patency and to remove any plugs. I would then perform an end to back anastomosis with a Dennis-Browne antemesenteric border split. 10% will have cystic fibrosis, so it is important to look for delta-f508 and related genes.

Dear Dr. Roy thank you so much for your simple and to the target answer. What I really did is nearly the same but I did side to side anastmosis after excision of the dilated ileal loop. But 3 days later the baby developed peritonitis and needed for re-entry that revealed a gangrenous ileal loop about 2 cm from the anastmosis that was sealed. An ileostomy has been done.

Thank you so much for sharing your experience