Congenital malformations of the gastrointestinal tract

Congenital malformations of the gastrointestinal tract are relatively rare diseases that can involve any part of the digestive system from the mouth to the anus and glands related to it. The severity of these diseases is highly variable, sometimes they are only occasional findings in asymptomatic patients, sometimes they are real emergencies that threaten the patient's life. In order to understand the genesis of gastrointestinal malformations it is useful to know the embryogenesis of gastrointestinal tract. The digestive system takes its origin from the three germ layers, endoderm gives rise to epithelia, ectoderm gives rise to the mouth and the anus, and mesoderm gives rise to muscle and connective tissue structures. The primitive gut is formed by tubulization of sheets. This tubular structure first undergoes obliteration of the lumen, and later a subsequent recanalization. Then the primitive gut gradually lengthens gradually and undergoes successive stages of rotation until the final disposition of the adulthood. Failure in one of these processes determines malformations in the definitive bowel. The main malformations of gastrointestinal tract are abnormalities of the intestinal lumen, including atresia, stenosis, and duplication; intestinal malrotation, volvulus; anal-rectal malformation; intestinal agangliosis; defect of abdominal wall, including gastroschisis and onphaloceles. Treatment of these malformations is mainly based on surgical correction, while the role of digestive endoscopy is primarily reserved to the post-surgical follow-up. In particular, patients suffering from esophageal atresia, with or without tracheoesophageal fistula, and undergoing surgery are burdened by a high post-surgical morbidity. Digestive endoscopy is useful in diagnosis, and sometimes in treatment of complications such as gastroesophageal reflux with esophagitis (or colitis in case of coloplastic), anastomotic stricture, and recurrent fistula.