Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions

Mucous fistula refeeding in neonates with enterostomies

BACKGROUND/PURPOSE

Neonates with intestinal pathology may require staged surgery with creation of an enterostomy and mucous fistula (MF). Refeeding (MFR) of ostomy output may minimize fluid and electrolyte losses and reduce dependence on parenteral nutrition (PN), though a paucity of evidence exists to support this practice. The purpose of this study was to assess the outcomes of infants undergoing MFR and document associated complications.

METHODS

With REB approval, infants with intestinal failure undergoing MFR between January 2000 and December 2012 were identified. A chart review was conducted and relevant data were collected. Descriptive statistics were used.

RESULTS

Twenty-three neonates underwent MFR. Mean gestational age and birth weight were 35weeks and 2416grams. Pathologies included intestinal atresia (n=12), necrotizing enterocolitis (n=5), meconium ileus (n=4), and other (n=6). Seven patients were able to wean from PN. Four patients had complications: 3 had perforation of the MF, 1 had bleeding. Four patients died, with one death directly attributable to MFR.

CONCLUSIONS

In this cohort MF refeeding was associated with significant complications and ongoing PN dependence. With advances in intestinal rehabilitation and PN, the benefit of MF refeeding must be weighed against the potential complications.

Gastrointestinal manometry findings in a case with dilated small bowel and disturbed transit treated successfully with bowel plication

We report the manometric findings in a case of dilated small bowel and disturbed transit successfully treated with plication of the dilated small bowel. The female newborn infant required total parenteral nutrition following an operation for small bowel atresia. X-ray showed a dilated proximal small bowel. Jejunal manometry showed normal phase 3 migration but persistently low-amplitude contractions in the dilated segment. After plication of the dilated intestine, symptoms of bowel obstruction disappeared. A second manometry two weeks after the operation showed contractions with normal amplitude. These findings indicate that: (1) disturbed transit in the dilated intestine proximal to small intestinal atresia is associated with persistently low contraction amplitude, and (2) the amplitude can be increased by the plication of the dilated loop.

Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistent partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were characterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.