Different results with early single-stage and staged repair in infants with ileal atresia: a two-case report on the effect of timing and treatment approach

Introduction and importance: Ileal atresia represents a major cause of newborn intestinal obstruction, requiring prompt surgical correction. Although a preferred procedure is the primary anastomosis in stable patients, the timing and surgical procedure can play a pivotal role in affecting morbidity, nutritional state, and the course of hospitalization. This article highlights the importance of these factors. Case presentation: We describe two neonates diagnosed with isolated ileal atresia and treated using two different techniques. In case 1, early primary anastomosis was performed on day 5 of life. This resulted in an uncomplicated postoperative period, along with the early introduction of oral feeding and a relatively short duration of hospitalization. On the other hand, case 2 underwent early stoma creation at birth, which was followed by poor weight gain, repeated infections, electrolyte disturbances, and severe peristomal skin excoriation caused by a high-output stoma. At nearly 3 months of age, the patient subsequently underwent delayed definitive repair with a primary end-to-end ileo–right colic anastomosis, after which catch-up growth was achieved, and the patient was discharged in stable condition. Clinical discussion: These cases demonstrate how surgical timing and approach may influence recovery and growth. Early single-stage repair, when feasible, is associated with shorter hospitalization and lower stoma-related morbidity. In contrast, staged management is accompanied by stoma-related complications and delayed nutritional recovery. Conclusion: Early single-stage repair should be prioritized in stable neonates with ileal atresia. When enterostomy is unavoidable, early stoma closure is advised to prevent malnutrition and caregiver strain.