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Percutaneous catheter decompression in a neonate with multiple small bowel atresias. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vinit N, Mitanchez D, Lemale J, Garel C, Jouannic JM, Hervieux E, Audry G, Irtan S. How can we improve perinatal care in isolated multiple intestinal atresia? A retrospective study with a 30-year literature review. Arch Pediatr 2021; 28:226-233. [PMID: 33674188 DOI: 10.1016/j.arcped.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/27/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Multiple intestinal atresia (MIA) is a rare cause of neonatal intestinal obstruction. To provide an overview of the current prenatal, surgical, and nutritional management of MIA, we report our experience and a literature review of papers published after 1990. METHODS All cases of isolated MIA (non-hereditary, not associated with apple-peel syndrome or gastroschisis) treated at our institution between 2005 and 2016 were reviewed and compared with cases found in the literature. RESULTS Seven patients were prenatally suspected of having intestinal obstruction and were postnatally diagnosed with MIA, with a mean 1.7 (1-2) resections-anastomoses (RA) and 6 (1-10) strictureplasties performed, resulting in a mean resected bowel length of 15.1cm (15-25 cm). Median time to full oral feed was 46 days (14-626 days). All patients were alive and none had orality disorder after a mean follow-up of 3.1 years (0.2-8.1 years). Three surgical strategies were found in the literature review: multiple RA (68%, 34/50) including Santulli's technique in four of 34 (12%) and anastomoses over a transanastomotic tube (32%, 16/50), with a 98% survival rate, and short-bowel syndrome for only two patients. CONCLUSION Bowel-sparing surgery and appropriate medical management are key to ensuring a favorable nutritional and gastrointestinal outcome and a good prognosis. Prenatal assessment and standardization of the surgical course of treatment remain challenging.
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Affiliation(s)
- N Vinit
- Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - D Mitanchez
- Department of Neonatology, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France
| | - J Lemale
- Department of Pediatric Nutrition and Gastroenterology, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - C Garel
- Department of Pediatric Radiology, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - J-M Jouannic
- Department of Obstetrics and Fetal Medicine, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France
| | - E Hervieux
- Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - G Audry
- Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France
| | - S Irtan
- Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France.
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Hamada H, Hamada Y, Doi T, Sekimoto M. Jejunoileal atresias associated with colonic atresia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options. Nevertheless, short and long-term complications following neonatal surgery continue to have profound and sometimes lasting effects on individual patients, families, and society.
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Affiliation(s)
- Mauricio A Escobar
- Pediatric Surgery, Mary Bridge Children׳s Hospital, PO Box 5299, MS: 311-W3-SUR, 311 South, Tacoma, Washington 98415-0299.
| | - Michael G Caty
- Section of Pediatric Surgery, Department of Surgery, Yale-New Haven Children׳s Hospital, New Haven, Connecticut
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Prolonged feeding difficulties after surgical correction of intestinal atresia: a 13-year experience. J Pediatr Surg 2014; 49:1593-7. [PMID: 25475800 DOI: 10.1016/j.jpedsurg.2014.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although surgical interventions for intestinal atresia are usually successful, oral feed intolerance could raise in certain cases. The aim of this study was to identify the factors that affect postoperative oral feed by retrospective analysis. METHODS Neonates meeting the inclusion criteria, who were admitted at our center from 1 January 2000 to June 2013, were enrolled into this retrospective study. Time to establishment of full oral intake (TOI), length of hospital stay (LOS) were outcome measures. Univariate and multiple regression were used. RESULTS Overall survival was 85.7%. Mean TOI was 20.4 ± 17.8 days, and mean LOS was 35.6 ± 44.8 days. Multivariate analysis confirmed a significant association with TOI for meconium peritonitis (P=0.024), luminal discrepancy between proximal and distal intestine (P=0.038), number of anastomoses (P=0.044), reportage of immature ganglion in proximal and/or distal intestine (P=0.029), and short bowel syndrome (P<0.001). Prematurity (P=0.022) increased the duration of hospitalization without affecting time to full oral intake. CONCLUSIONS Meconium peritonitis, luminal discrepancy, number of anastomoses, reportage of immature ganglion, and short bowel syndrome were factors related to prolonged feeding difficulties. We advocate alertness for patients with these factors to reduce postoperative morbidity and treatment costs.
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Sapin E, Joyeux L. Multiple intestinal anastomoses to avoid short bowel syndrome and stimulate bowel maturity in type IV multiple intestinal atresia and necrotizing enterocolitis. J Pediatr Surg 2012; 47:628. [PMID: 22424368 DOI: 10.1016/j.jpedsurg.2011.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/28/2022]
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Romão RLP, Ozgediz D, de Silva N, Chiu P, Langer J, Wales PW. Preserving bowel length with a transluminal stent in neonates with multiple intestinal anastomoses: a case series and review of the literature. J Pediatr Surg 2011; 46:1368-72. [PMID: 21763836 DOI: 10.1016/j.jpedsurg.2011.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/05/2011] [Accepted: 01/17/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE In neonatal surgery, preserving small bowel length is important to avoid short bowel syndrome. Our aim was to assess the outcomes of intraluminal stenting of neonatal multiple intestinal anastomoses. METHODS We conducted a retrospective review of 9 patients (5, single institution; 4, published literature) who received multiple anastomoses stented by a silicon tube. Demographics, surgical anatomy and complications, nutritional outcomes, and follow-up were reviewed. RESULTS Diagnosis was multiple intestinal atresias in 8 patients and necrotizing enterocolitis in 1. A silicon catheter entered either the mucous fistula (5 patients received a jejunostomy/mucous fistula) or a proximal opening on the dilated bowel and was threaded through viable segments of the bowel. The bowel ends were approximated. Stent was externalized in 7 patients. Final mean small bowel length was 63.9 cm. All complications (3 patients, leak/stricture) required surgery. Mean time to stent removal, feeds initiation, and parenteral nutrition (PN) discontinuation was 31.2 days, 17.3 days, and 159 days, respectively. Only 1 patient remains on PN (mean follow-up, 25.4 months). CONCLUSIONS Multiple intestinal anastomoses stenting is an excellent technique to avoid short bowel syndrome in the setting of multiple viable segments of gut, such as type IV intestinal atresia or necrotizing enterocolitis. Both our experience and the published literature show no mortality and PN-free survival.
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Affiliation(s)
- Rodrigo L P Romão
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Luo CC, Ming YC, Chu SM, Chao HC. Individualized management of upper rectal atresia. J Pediatr Surg 2009; 44:2406-9. [PMID: 20006038 DOI: 10.1016/j.jpedsurg.2009.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/15/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Congenital colonic atresia (CA) or stenosis is an infrequent cause of low intestinal obstruction in the neonate. Atresias can occur at any level, and the management of CA is determined by the atretic site and by the presence or absence of associated anomalies. We report our experience dealing with upper rectal atresia during a 5-year period. METHODS Between January 2004 and December 2008, 3 female newborns with upper rectal atresia with or without associated anomalies were treated. Modes of clinical presentation, methods of diagnosis, associated anomalies, alternative management techniques, and clinical outcome were retrospectively analyzed. RESULTS All 3 patients had progressive abdominal distension, bilious vomiting, and failure to pass meconium. Contrast enema showed an atresia at the upper rectum in 2 patients. At laparotomy, case 1 was found to have type III atresia of the upper rectum. Resection of the dilated portion of the proximal colon with end sigmoid colostomy was accomplished in the neonatal period followed by a transanal mucosectomy with takedown of the colostomy and a pull-through procedure at age 3 months. Case 3 had multiple jejunoileal atresias and an upper rectal atresia. The initial management was multiple resections of atretic bowel and anastomoses and an end sigmoid colostomy. The secondary procedure was a takedown of the colostomy and transanal mucosectomy with a pull-through procedure. Case 2 had type I upper rectal atresia in association with imperforate anus complicated by colon perforation during performance of a distal colostogram leading to a complicated and protracted clinical course. All the patients are currently well with voluntary bowel movements, and one has occasional soiling with follow-up of 9 months to 3 years. CONCLUSIONS Colon atresia, especially at the level of the upper rectum, is uncommon. Whether to proceed with an ostomy or to individualize the operative procedure according to the location of the atresia is still controversial. Transanal mucosectomy was a useful technique at the time of the definitive pull-through for the treatment of upper rectal atresia. In cases of upper CA associated with imperforate anus, delay in diagnosis and potential complications may result if the diagnosis of upper rectal atresia is missed.
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Affiliation(s)
- Chih-Cheng Luo
- Department of Pediatric Surgery, Chang Gung Children's Medical Center, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
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