Colonic atresia is a rare birth defect where part of the large intestine is blocked or missing. Newborns with colonic atresia typically develop early symptoms of bowel blockage such as a swollen belly, vomiting, and no passage of stool. It is present at birth and needs urgent surgical repair to connect the bowel and prevent serious infection. Most babies do well after surgery, but recovery and long-term bowel function can vary. Ongoing care may include nutrition support and monitoring growth in infancy and childhood.
Overview
Colonic atresiaSymptoms
Colonic atresia usually shows in newborns with a swollen belly, vomiting green bile, and failing to pass the first stool (meconium). Early signs of colonic atresia can also include poor feeding and dehydration as hours pass.
Outlook and prognosis
Many people with colonic atresia do well after timely surgery, especially when it’s the only bowel issue. Recovery depends on how much intestine is affected and whether other conditions are present. With skilled neonatal care and follow‑up, growth and feeding usually improve.
Causes and risk factors
Colonic atresia is congenital, usually from disrupted fetal colonic blood flow. It may follow in‑utero volvulus, internal hernia, or intussusception, and is linked to abdominal wall defects, malrotation, Hirschsprung disease, and cystic fibrosis; inherited cases are rare.
Genetic influences
Genetics play a meaningful role in colonic atresia, though many cases are isolated. Variants linked to intestinal development, vascular disruption, or syndromes (like cystic fibrosis) can contribute. Family history, consanguinity, or multiple anomalies increase the likelihood of a genetic cause.
Diagnosis
Doctors suspect colonic atresia in newborns with abdominal swelling and no meconium. The diagnosis of Colonic atresia relies on clinical features and imaging—usually abdominal X-rays and contrast enema—to locate the blockage. Prenatal ultrasound or, rarely, genetic tests may support evaluation.
Treatment and drugs
Treatment for colonic atresia focuses on timely surgery to open or remove the blocked segment and reconnect healthy bowel. Newborns often need IV fluids, a nasogastric tube, and sometimes a temporary stoma to protect healing. Ongoing care includes nutrition support and follow-up to monitor growth and bowel function.
Symptoms
In the first day or two after birth, some babies feed poorly, vomit, or develop a swollen belly; these can be signs of a blocked large intestine. Early on, this might look like trouble feeding, a swollen belly, and no first poop. When a section of the colon is missing or closed off, called colonic atresia, these signs tend to show up quickly. Parents often notice early features of colonic atresia within 24–48 hours of birth.
A baby’s tummy becomes round and firm as gas and fluid build up behind the blockage. With colonic atresia, this swelling can appear within the first day of life.
The newborn does not pass the first stool (meconium) in the first 24–48 hours. In colonic atresia, stool cannot reach the rectum, so diapers stay clean or show only a little mucus.
Vomit can look yellow-green when bile backs up. In medical terms, this is bilious vomiting; in everyday life, it shows up as green-stained vomit.
Feeds may be hard to keep down, and the baby may pull away or spit up soon after eating. With colonic atresia, feeding often makes the belly feel tighter and more uncomfortable.
How people usually first notice Colonic atresia?
Many families first notice something is wrong soon after birth when a newborn doesn’t pass meconium in the first day, has a swollen belly, and begins vomiting bile that looks bright yellow-green. Doctors often suspect colonic atresia during the first hours to days of life based on these blockage signs and an abdominal X‑ray showing air-fluid levels with little or no gas in the lower bowel; sometimes it’s first suggested prenatally if ultrasounds show dilated bowel loops. These are the typical first signs of colonic atresia and explain how colonic atresia is first noticed before confirmation with imaging and surgical evaluation.
Types of Colonic atresia
Colonic atresia has a few well-recognized variants based on where the blockage sits and how the bowel ends are formed. These variants matter because they shape early symptoms—like how soon bloating appears after birth and whether the first stool passes—and they guide the surgery a baby will need. Clinicians often describe them in these categories: location along the colon and the anatomic pattern of the atresia. Knowing the main variants of colonic atresia can help families understand what to expect and the types of colonic atresia a surgeon may discuss.
Ascending colon
The blockage is in the first part of the large bowel on the right side. Babies often develop quick belly swelling and vomiting within the first day. Surgeons frequently create a temporary stoma before reconnecting later.
Transverse colon
The atresia sits across the upper abdomen. Vomiting may include bile, and the belly can look distended but sometimes later than with right-sided blockages. X‑rays usually show large loops of bowel with little gas beyond the blockage.
Descending colon
The blockage is on the left side as the colon heads downward. Babies may have fewer episodes of vomiting but marked abdominal bloating and no passage of meconium. The left-sided location can influence which segments are safe to join.
Sigmoid colon
The atresia is near the lower left curve of the colon. Distention can be prominent and meconium typically does not pass. A staged repair is common if the downstream segment is small or inflamed.
Type I (membrane)
A thin membrane blocks the inside of the colon while the outer wall stays connected. Symptoms can be slightly less abrupt but still include early swelling and vomiting. Surgery removes the membrane and restores flow.
Type II (blind ends)
The colon ends in two blind pouches connected by a cord that has no open channel. Newborns usually show early obstruction with no meconium passage. Surgeons remove the gap and join healthy ends.
Type III (gap/mesentery)
The blind ends are separated by a gap and a V‑shaped defect in the supporting tissue. Symptoms are typically early and pronounced, and nearby bowel may be shorter or affected. Repair often needs resection and careful reconstruction.
Multiple atresias
More than one blocked segment is present along the intestine. Babies can have severe, early symptoms and may need several resections. Outcomes depend on how much healthy bowel remains after surgery.
What genetics can tell you about symptoms
Certain gene changes, like mutations in CFTR linked to cystic fibrosis, can disrupt intestinal development and lead to colonic atresia with abdominal swelling, bilious vomiting, and failure to pass meconium. Variants affecting vascular development may cause similar blockage symptoms shortly after birth.
Causes and risk factors
Colonic atresia starts before birth when a section of the colon does not form a normal passage. The most likely cause is a brief loss of blood flow to that area in the womb, and less often a problem in how the bowel develops. Parents usually notice early symptoms of colonic atresia soon after birth, even though the cause traces back to pregnancy. Most cases are not inherited, though rare families have genetic forms or other birth differences along with it. Doctors distinguish between risk factors you can change and those you can’t, and for colonic atresia there are no proven lifestyle or everyday environmental links in pregnancy.
Environmental and biological risk factors
Colonic atresia is rare, but understanding what can raise its chances can ease some uncertainty during pregnancy. Doctors often group risks into internal (biological) and external (environmental). Most known risks relate to events that disturb blood flow to a section of the baby’s colon or physically pinch the bowel before birth. This overview highlights risk factors for colonic atresia.
A short-term loss of blood supply to a section of the developing colon can stop that part from forming normally. This vascular disruption is the leading biological pathway behind colonic atresia. In many pregnancies, the exact trigger is never identified.
Twisting of the intestine before birth (volvulus) can pinch the blood vessels that feed the large bowel. If circulation is cut off long enough, the damaged segment may heal as a gap or blockage.
Loops of bowel can slip through small openings or get caught under fibrous bands inside the abdomen. This entrapment squeezes the blood flow, increasing the chance that a colon segment won’t develop properly.
One part of the bowel sliding into another can block circulation to the trapped section. When this happens in the colon during fetal life, it can end in atresia.
Genetic risk factors
Most cases of colonic atresia happen as isolated events with no clear inherited cause. Still, doctors have found a few genetic patterns that can raise the chance in some families or link colonic atresia with other conditions. Some risk factors are inherited through our genes. Genetic causes of colonic atresia are uncommon, and testing is usually guided by the baby’s features and family history.
Usually not inherited: Most babies with colonic atresia are the only affected person in their family. No single gene has been shown to cause most cases.
Cystic fibrosis link: Colonic atresia can occur in infants who have cystic fibrosis, a condition caused by changes in the CFTR gene. If cystic fibrosis runs in a family, newborn screening and CFTR testing can clarify this risk.
Hirschsprung overlap: Rarely, this condition occurs together with Hirschsprung disease, which involves missing nerve cells in the colon. When this overlap is present, genes such as RET and EDNRB may be involved in the family’s risk.
Multiple atresia syndromes: Very rare inherited disorders like multiple intestinal atresia can include the colon as well as the small intestine. These usually run in families when both parents carry the same hidden variant and may involve genes such as TTC7A.
Family history: Having a sibling or close relative with intestinal atresia or Hirschsprung disease slightly increases the chance of this condition in future pregnancies. The absolute risk remains low in most families.
Parental relatedness: When parents are closely related by blood, recessive conditions become more likely, which can include rare inherited forms of intestinal atresia. Genetic counseling can explain personal risk before or during pregnancy.
Lifestyle risk factors
Colonic atresia is a congenital condition; lifestyle habits do not cause it, but they can influence symptoms, recovery after surgery, and risks of complications like constipation or functional obstruction. Understanding how lifestyle affects colonic atresia can help improve stooling patterns, reduce discomfort, and support growth. The elements below focus on day-to-day choices that can shape outcomes after repair or with a stoma.
Adequate fluids keep stools soft and reduce constipation risk after colonic atresia repair. Dehydration can trigger hard stools and functional blockage, especially in segments with scarring or narrowing.
Gradual, tailored fiber can promote regularity without creating bulky stools that are hard to pass through a repaired or narrowed colon. Emphasizing soluble fiber (oats, applesauce) over large amounts of insoluble fiber may lower straining.
Small, regular meals support steady transit and lessen bloating in a shortened or surgically altered colon. Large, infrequent meals can provoke cramps and unpredictable stooling.
Daily movement stimulates gut motility and helps prevent constipation after colonic surgery. Prolonged sedentary time can slow transit and increase straining and leakage.
Risk prevention
True prevention of colonic atresia isn’t currently possible, since it develops before birth and the exact cause is often unknown. Prevention is about lowering risk, not eliminating it completely. Good preconception planning, careful prenatal care, and delivery planning at a hospital with newborn surgery can reduce complications and improve outcomes. Families with a prior affected pregnancy or cystic fibrosis in the family may benefit from genetic counseling before conception.
Meet with a genetic counselor if you’ve had a baby with colonic atresia or there’s cystic fibrosis in the family. They can discuss recurrence risk and offer carrier screening for cystic fibrosis before pregnancy. This helps guide planning and care early.
Regular antenatal visits and ultrasounds can sometimes pick up bowel swelling that raises concern for colonic atresia. Prevention works best when combined with regular check-ups. If suspected, your obstetric team can plan care and referral in advance.
Avoid tobacco, alcohol, and recreational drugs, and review all medications with your clinician before and during pregnancy. Managing infections and chronic conditions may lower risks that can affect blood flow to a developing intestine. These steps support overall fetal health, even though they can’t fully prevent colonic atresia.
If colonic atresia is suspected before birth, plan delivery at a center with neonatal intensive care and pediatric surgery. This reduces delays to diagnosis and treatment, which can lower the chance of complications. Your obstetrician can coordinate transfer if needed.
Transmission
Colonic atresia isn’t contagious; it can’t be spread between people. It’s present at birth and usually arises while the baby is developing in the womb, often from a disruption in intestinal growth such as a brief loss of blood flow to part of the colon. Most cases are sporadic and not inherited; how colonic atresia is inherited matters mainly when it appears with a rare genetic syndrome or when more than one child in a family is affected. In those uncommon situations, a genetic counselor can discuss likely patterns and the chance of recurrence in a future pregnancy.
When to test your genes
Consider genetic testing if colonic atresia appears in a newborn alongside other birth differences, or if there’s a family history of intestinal atresias or related syndromes. Testing can clarify cause, guide surgical planning and nutrition, and inform screening for associated conditions. It also helps families understand recurrence risk and plan future pregnancies.
Diagnosis
Colonic atresia is usually identified soon after birth based on how a newborn is doing and what imaging shows. Parents often first notice a swollen tummy, green (bilious) vomiting, or no first stool, and wonder how diagnosis of colonic atresia is made. Getting a diagnosis is often a turning point toward answers and support. Doctors then confirm the blockage and its location with targeted tests so surgery can be planned safely.
Providers look for swollen bowel loops and extra fluid around the baby as possible early clues. These findings can raise suspicion, but they are not specific for colonic atresia.
Doctors assess belly swelling, green vomiting, and whether the baby has passed meconium. A gentle rectal check and overall stability assessment help guide urgent next steps.
Plain X-rays can show multiple swollen bowel loops with little or no gas in the lower abdomen. This pattern suggests a blockage and helps distinguish high versus low obstruction.
A small amount of water‑soluble contrast is placed into the rectum to outline the colon. In colonic atresia, the colon may look very small (a “microcolon”) with a clear stop point, helping pinpoint the level of blockage.
Stages of Colonic atresia
Colonic atresia does not have defined progression stages. It’s a blockage of the large intestine present from birth, so the focus is on quick recognition and surgery rather than a slow, stepwise decline. Early symptoms of colonic atresia can include a swollen belly, not passing the first stool (meconium), and green or yellow vomiting in the first day or two of life. Different tests may be suggested to help confirm the diagnosis, such as a physical exam, abdominal X‑rays, and a contrast enema to pinpoint the blockage; in some cases, a prenatal ultrasound or blood tests add helpful clues.
Outlook and prognosis
Looking ahead can feel daunting, but most babies with colonic atresia do well after timely surgery and careful follow-up. Early care can make a real difference, especially when treatment happens soon after birth to prevent dehydration, infection, or bowel damage. After surgical repair (often a staged approach with a temporary ostomy), many children grow, gain weight, and reach milestones on track, though some need extra nutrition support in the first months.
The outlook is not the same for everyone, but survival after modern neonatal surgery is high in centers experienced with complex bowel conditions. Risks are higher if there are additional problems such as low birth weight, severe infection, or other gastrointestinal differences. Some children develop short bowel symptoms, strictures at the join, or bowel motility issues that can mean more time to learn feeding or a later procedure; early symptoms of colonic atresia complications can include vomiting, swollen belly, poor weight gain, or unusual ostomy output. With ongoing care, many people maintain good growth and activity, attending school and play with few limits.
Understanding the prognosis can guide planning and day-to-day expectations for feeding, stool patterns, and growth checks. Long-term, many children transition off special formulas and see their care teams less often, though periodic reviews help catch nutrient gaps, anemia, or vitamin losses. Rarely, severe short bowel or repeated infections can affect long-term health and raise mortality risk, but this is uncommon when care is coordinated early and complications are managed promptly. Talk with your doctor about what your personal outlook might look like, including nutrition goals, signs of blockage or infection to watch for, and the plan for ostomy reversal if one is in place.
Long-term effects
After surgery in infancy, many grow up healthy, but the long-term effects of colonic atresia depend on how much bowel was removed and whether other conditions were present. Long-term effects vary widely, and many people do well with only minor differences in digestion over the years. Some live with changes in bowel habits, while others may face nutrition or growth challenges, especially if large sections were taken out. Doctors often describe these as long-term effects or chronic outcomes.
Some children grow more slowly in the early years, especially if a longer segment of bowel was removed. Many catch up over time once digestion becomes more efficient.
Ongoing loose stools or constipation can follow surgery. For many, symptoms settle into a new baseline during childhood or adolescence.
If a large portion of intestine was removed, the body may absorb less fluid and nutrients. This can lead to frequent stools, dehydration risk, and difficulty maintaining weight.
Scar tissue inside the abdomen (adhesions) can occasionally kink or block the bowel. This risk can appear months to years after surgery for colonic atresia.
How is it to live with Colonic atresia?
Life with colonic atresia usually begins in the newborn period with urgent surgery, followed by weeks to months of careful feeding plans, growth checks, and stoma or wound care if a temporary ostomy is used. As the child grows, many families manage stooling patterns that can be unpredictable at first—ranging from loose stools to constipation—along with attention to hydration, skin care, and nutrition to support steady weight gain. Daily life often includes regular follow-ups with pediatric surgery and gastroenterology, but most children can join in typical activities as recovery stabilizes, and routines become easier. For parents and caregivers, the early phase can be intense and emotional; support from clinicians, family, and peer groups helps ease the load and gives confidence for day-to-day care.
Treatment and drugs
Colonic atresia is treated with surgery, usually soon after birth, to open or remove the blocked segment of the colon and reconnect healthy ends so stool can pass normally. Before surgery, babies often receive fluids through a vein, a tube to drain the stomach, and antibiotics to lower infection risk; some newborns need a temporary colostomy, which surgeons can close in a later operation. Treatment plans often combine several approaches, and the surgical method depends on the exact location and length of the blockage, the baby’s size, and whether there are other bowel issues. After surgery, care focuses on pain control, gentle feeding plans, and careful monitoring for problems like leaks at the join, narrowing (stricture), or infection. Although living with colonic atresia can feel overwhelming, many babies recover well with prompt surgery and follow‑up from a pediatric surgery team.
Non-drug treatment
Colonic atresia usually requires surgery soon after birth, but several non-drug treatments help stabilize your baby and ease recovery. Alongside medicines, non-drug therapies can support breathing, feeding, comfort, and family learning from day one. These steps start when early symptoms of colonic atresia—like a swollen belly or failure to pass stool—bring a newborn to care. They continue after surgery to protect nutrition, skin, and healing.
A soft tube placed through the nose into the stomach gently removes air and fluid to relieve pressure. This helps reduce vomiting and protects the lungs from aspiration. It also makes surgery safer by keeping the bowel less distended.
Fluids given through a vein prevent dehydration and balance salts when the bowel cannot be used. Careful monitoring keeps blood sugar and hydration stable before and after surgery.
If feeding by mouth or tube is not yet possible, nutrients are delivered through a vein to support growth and healing. The team adjusts proteins, fats, and vitamins based on your baby’s needs until feeds can increase.
Specialists guide a gradual plan from tiny trial feeds to full feeds as the bowel recovers. Lactation support can help parents provide breast milk, which is gentle on the gut and supports immunity.
Your genes may have an impact on how drugs work for you
Tiny differences in your genes can change how your body processes anesthesia, pain medicines, and antibiotics often used around surgery, affecting dose needs and side‑effect risk. Doctors sometimes use family history or pharmacogenetic tests to tailor safer, more effective medication plans.
Pharmacological treatments
Medicines for colonic atresia are used to stabilize and protect a newborn before and after surgery; they do not open the blockage. The goals are to prevent infection, manage pain, and reduce complications around the operation. Alongside drug therapy, surgery and nutrition support remain important. Before surgery, early symptoms of colonic atresia such as vomiting and a swollen belly are addressed with stomach decompression and fluids, while antibiotics are started to lower infection risk.
Ampicillin plus gentamicin are started to cover common bacteria in newborns. Metronidazole is often added to cover gut anaerobes when colonic atresia is suspected. Doses are adjusted for birth weight and kidney function.
Piperacillin–tazobactam can be used as broad coverage when a combined regimen isn’t ideal. It targets many gut bacteria, including some anaerobes. Doctors may choose it if dosing simplicity is important.
Cefazolin plus metronidazole are commonly given right before surgery to reduce wound and abdominal infections. Timing is coordinated with anesthesia so levels are highest at the incision. A repeat dose may be given if surgery is prolonged.
If infection is suspected, vancomycin plus cefotaxime may be used while cultures are pending. Metronidazole can be added if an abdominal source is likely. Treatment is narrowed once the lab results identify the bacteria.
Genetic influences
Most cases of colonic atresia happen as a one-time event during early development and are not inherited. Some people wonder if their condition could be “in the genes.” In a small number of families, gene changes may contribute, but for most, colonic atresia does not follow a clear family pattern. Rare, inherited cases have been reported—sometimes when both parents carry the same silent gene change—and it can occasionally appear alongside genetic conditions such as Hirschsprung disease. Because of this mix, the chance of it happening again in a family is generally low, but it may be higher if a known syndrome is present or more than one relative is affected. If you’re wondering about the genetic causes of colonic atresia in your family, a genetics professional can review your family history and, if needed, discuss testing.
Is Colonic atresia genetic?
Genetics play a meaningful role in colonic atresia, though many cases are isolated. Variants linked to intestinal development, vascular disruption, or syndromes (like cystic fibrosis) can contribute. Family history, consanguinity, or multiple anomalies increase the likelihood of a genetic cause.
Pharmacogenetics—how genetics influence drug effects
Surgery is the main treatment for colonic atresia, but genes can still influence which medicines are safest and how a baby responds. Before and during surgery, anesthesia teams consider inherited risks such as malignant hyperthermia, which can make certain gas anesthetics dangerous; if a family member has had a severe reaction, they’ll choose different drugs. Rare enzyme differences can also cause very slow breakdown of the muscle relaxant succinylcholine, which may lead to longer breathing support after surgery, so alternatives are used when this is known. After surgery, certain antibiotics (like gentamicin) may be needed; a specific change in mitochondrial DNA can greatly raise the chance of hearing damage from these drugs, so teams may avoid them or monitor closely if a baby is at risk. For pain control, newborns don’t receive codeine, and other opioids are dosed cautiously because development and genetic factors together affect how quickly a baby clears them. Genetic testing can sometimes identify how your body handles certain medicines, guiding safer choices during and after surgery. Genetics rarely change the need for the operation in Colonic atresia, but they can shape the plan for medications used during surgery for Colonic atresia, especially when there’s a known family history of anesthesia reactions or antibiotic-related hearing loss.
Interactions with other conditions
Colonic atresia often appears alongside other birth differences in the digestive tract, which can change both the timing and the type of surgery a baby needs. To understand overall health, it’s useful to see how conditions overlap. It may occur with small‑bowel atresia, intestinal malrotation, or abdominal wall defects such as gastroschisis; when these travel together, feeding plans, infection prevention, and the risk of short‑bowel problems after surgery can all shift. A smaller group of babies have both colonic atresia and Hirschsprung disease (a nerve‑related blockage of stool movement), and this pairing matters because surgeons may need to adjust how and when the colon is reconnected and often check bowel tissue during treatment. Less commonly, heart or kidney differences are also present and can influence anesthesia choices, fluid balance, and recovery in the newborn period. Early symptoms of colonic atresia—such as a swollen belly, vomiting, and no passage of stool—may look different or be harder to spot when another condition like gastroschisis is present, so teams coordinate care closely to avoid delays and complications.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Throughout history, people have described newborns who stopped passing stool, fed poorly, and developed a swollen belly within the first days of life. Families and midwives noticed that no home remedy helped, and surgeons in the late 19th and early 20th centuries began recording these urgent cases. From early theories to modern research, the story of colonic atresia shows how careful observation gradually turned a mysterious, often fatal newborn emergency into a condition that can be identified and treated.
Early medical reports focused on what could be seen: a baby with progressive abdominal distension, bile-stained vomiting, and no meconium. Before imaging or newborn intensive care, survival was uncommon, and the colon was often examined only during autopsy. As surgical practice advanced, clinicians recognized that the blockage could sit anywhere along the large intestine, and that the exact location shaped both symptoms and the operation needed to fix it.
In the mid-20th century, safer anesthesia, antibiotics, and fluid management allowed more infants to reach surgery. Pediatric surgeons described distinct patterns of colonic atresia and refined techniques to reconnect the bowel or create temporary stomas. X-rays and contrast studies helped pinpoint the blockage before opening the abdomen, shortening procedures and improving outcomes. With each decade, survival rose as postoperative nutrition and neonatal care improved.
Advances in prenatal care brought the next shift. Ultrasound sometimes flagged bowel swelling before birth, prompting delivery in centers ready for immediate evaluation. As genetics matured, researchers asked whether colonic atresia clustered with other anomalies or rare inherited conditions. While most cases appear isolated and without a clear family link, DNA research now explains a minority of cases that occur alongside broader developmental syndromes or vascular events affecting the fetal gut.
By the late 20th and early 21st centuries, teams standardized early symptoms of colonic atresia and clarified the difference between what families notice at home or in the nursery and what clinicians see on imaging and exam. The condition moved from “almost always fatal” to “often survivable,” with long-term outlook shaped by the atresia’s location, associated conditions, and how much colon could be preserved.
Today’s understanding rests on that layered history. Surgeons still rely on the classic early clues described generations ago, but they pair them with modern imaging, genetic testing when appropriate, and coordinated neonatal care. Looking back helps explain why timing matters so much: prompt recognition, careful stabilization, and timely surgery reflect lessons learned over more than a century of caring for infants with colonic atresia.