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PubMed1980

Advances in the management of gastroschisis.

Twenty-eight cases of gastroschisis have been treated over a five-year period. Twenty-two silos were placed and 19 infants had uncomplicated silo closure. Enlargement of the abdominal wall defect to allow optimum reduction of the edematous bowel was essential to closure in less than a week. Rapid removal of the prosthesis and strict adherence to aseptic technique prevented septic complications. Inability to return the bowel to the abdominal cavity within five to six days mandated re-exploration to determine the cause for failure to reduce the silo. Accordingly, three infants were re-explored. Two patients had unrecognized intestinal lesions and a third infant, whose defect had not been enlarged, had infarction of the midgut. Six infants underwent primary closure; two with preinatal evisceration and four who had concomminant cutaneous enterostomies performed for intestinal atresia. Intestinal atresia or stenosis occurred in 25% of these infants. Postoperative management was facilitated by insertion of a gastrostomy tube, early peripheral venous nutrition and later insertion of a central venous catheter for nutrition. The one postoperative death (3.5% mortality rate) resulted from failure to follow the principles of silo management as outlined in this report.

Abdominal Muscles↗
PubMed1976

[Problems of anesthesia and recovery in neonatal surgery. Personal experience during ther period 1970-1975].

On the basis of personal experience during the past five years, the anaesthesiological and resuscitatory problems of neonatal surgery are considered, with special regard to the following pathological conditions: oesophageal atresia, diaphragmatic hernia, omphalocele and gastroschisis, neonatal peritonitis, anal atresia, intestinal atresia and stenosis. It is stated that the new post-operative care tecniques have not only improved survival percentages, but, in the case of oesophageal atresia, have made it possible to operate (radically) even in seriously immature babies with ongoing complications.

Anesthesia↗
PubMed1977

[First aid measures in emergency pediatric surgery (author's transl)].

The type of first aid given to patients requiring emergency pediatric surgery is decisive for the prognosis in many cases. With this aspect in mind, individual disease pictures from the group of connatal deformities (esophageal atresia, intestinal atresia, gastroschisis, diaphragmatic hernia and defect, myelomeningocele), from emergency surgical situations beyond the neonatal stage (acute abdomen and ileus, esophageal varices, pneumothorax), and accident injuries (blunt abdominal trauma, cranio-cerebral trauma, burns) are selected and the most important first aid measures described. But for all diseases, the general rule for the treatment of all seriously ill children applies: provision of a safe venous access, readiness to intubate, adequate oxygenation and control of the acid-base, water and electrolyte balances.

Abdomen, Acute↗
PubMed2004

Nervous system development in normal and atresic chick embryo intestine: an immunohistochemical study.

Intestinal motility disorders are a common complication after surgery for neonatal intestinal atresia. Although intestinal atresia causes alterations in the enteric nervous system, especially in its inner structures (nervous fibers in the mucosa, submucous and deep muscular plexuses), how these alterations develop is unclear. The chick model is a useful research tool for investigating the ontogenesis of the enteric nervous system and the pathogenesis of congenital bowel diseases. More information is needed on the overlap between the developing enteric nervous system and intestinal atresia. Because vasoactive intestinal polypeptide and substance P are typical intestinal neuropeptides, and vasoactive intestinal polypeptide acts as a modulator in neurodevelopment and an inhibitor of smooth muscle cell proliferation, our aim in this study was to investigate the distribution of their immunoreactivity in the developing enteric nervous system of normal and experimental chick models. We studied gut specimens excised from normal chick embryos (aged 12-20 days) and experimental chick embryos (aged 15-20 days) that underwent surgical intervention on day 12 to induce intestinal atresia (atresic embryos) or simply to grasp the bowel loop (sham-operated embryos). In normal chick embryos we showed vasoactive intestinal polypeptide and substance P immunoreactivity from day 12 in the submucous and myenteric plexuses. The distribution of peptide immunoreactivity differed markedly in atresic and normal or sham-operated gut embryos. These differences especially affected the inner structures of the enteric nervous system of specimens proximal to atresia and were related to the severity of dilation. Because nerve structures in the gut wall mucosa and submucous and deep muscular plexuses play a role in motility control and stretch sensation in the intestinal wall, our findings in the chick embryo may help to explain how gut motility disorders develop after surgery for neonatal intestinal atresia.

Animals↗
PubMed2001

Colonic stricture secondary to torsion of an ovarian cyst.

Intestinal obstruction in the newborn is a potentially life-threatening complication. The most common causes are meconium plug, meconium ileus, intestinal atresia, intestinal malrotation, and Hirschprung's disease. We present an unusual case of intestinal obstruction caused by torsion of an ovarian cyst. The left fimbria and ovary swirled around the sigmoid colon, causing colonic stricture.

Colon↗
PubMed1988

[Surgical treatment and problem of massive small intestinal resection in children--assessment of background diseases and actual management].

From 1971 to 1986, massive small intestinal resection was done in twenty-five cases; intestinal atresia 12, intestinal volvulus 9, necrotizing enterocolitis 2, intussusception 1 and gastroschisis 1. Thirteen cases (52%) of them have survived. Of 12 cases with intestinal atresia undergoing small intestinal resection, 7 cases had atresias of multiple type, on the other hand, in intestinal volvulus, 4 of 9 cases without malrotation have had massive small intestinal resection, compared with 5 of 30 cases with malrotation. Many clinical problems have occurred after massive small intestinal resection, especially in cases with short bowel syndrome (shorter than 30 cm in length), but home parenteral nutrition has become one of the key treatments for cases with short bowel syndrome.

Child↗
PubMed1999

Multiple atresias in a low-birth-weight twin.

This report describes a case of 16 small bowel atresias in a twin who was born at 31 weeks' gestation, weighing 1,690 g. All atresias and intestinal segments of 5 cm or less in length were resected, resulting in nine primary anastomoses, preserving 75% (107 cm) of his initial small bowel length. The baby went home on full oral feedings after 10 weeks. Multiple anastomoses in the low-birth-weight neonate can be tolerated with the functional benefit of maximal bowel length. The time taken to tolerate feedings appears to be independent of the number of anastomoses. Vascular anastomoses associated with monochorionic twinning may place both fetuses at risk of intestinal atresia in the event of an ischemic insult, either concurrently or with the demise of one affecting the other. Prenatal ultrasound scan appears to be useful for monitoring the evolution of intestinal atresia. However, the risks of extreme prematurity preclude the delivery of the affected baby at the time of initial diagnosis, and as yet it is unknown whether early delivery will alter the number, type, or prognosis of multiple atresias.

Diseases in Twins↗
PubMedDate not supplied

Diagnosis and treatment of jejunoileal atresia.

A total of 116 cases of intestinal atresia or stenosis were encountered at the Yale-New Haven Hospital between 1970 and 1990. Sites involved were the duodenum (n = 61; 53%), jejunum or ileum (n = 47; 46%), and colon (n = 8; 7%). All but two patients underwent operative correction, for an overall survival rate of 92%. Challenging problems were the management of apple-peel atresia (five patients), multiple intestinal atresia with short-gut syndrome (eight patients), and proximal jejunal atresia with megaduodenum requiring imbrication duodenoplasty (four patients). Major assets in the improved outlook for intestinal atresia are prenatal diagnosis, regionalization of neonatal care, improved recognition of associated conditions, innovative surgical methods, and uncomplicated long-term total parenteral nutrition.

Anastomosis, Surgical↗
PubMed1986

Developmental aspects of gastroschisis.

The development of gastroschisis was studied experimentally as well as clinically, particularly concerning the characteristic fibrous coating of the protruding bowel loops, associated intestinal atresia, and postoperative hypoperistalsis without intestinal obstruction. Experimental investigation was carried out in the chicken embryo. The clinical study was a joint one, involving a total of 50 patients with gastroschisis seen at the Sophia Children's Hospital, Rotterdam, and the Royal Hospital for Sick Children, Glasgow, between 1972 and 1985. Some patients were followed antenatally. The results, correlating with previous experiments, were compared with data from the literature. The fibrous coating of the protruding bowel loops appeared to be a late occurrence and directly related to changes of the amniotic fluid secondary to the onset of renal function. Associated intestinal atresia and postoperative hypoperistalsis in the absence of an obstruction both appeared to be due to another late gestational event, consisting of ischemic changes of the bowel wall secondary to the compression of bowel loops and mesentery in the small abdominal wall defect.

Abdominal Muscles↗
PubMed2003

Gastroschisis: A sixteen-year review.

PURPOSE: The aim of this study was to examine the incidence of gastroschisis in Saskatchewan over a 16-year period and identify risk factors associated with mortality. METHODS: Information was obtained by retrospective review of all infant charts at the only 2 provincial neonatal intensive care centers from January 1985 through December 2000. Factors recorded were gestational age, birth weight, gender, Apgar score, time to operation, method of closure, time to attain full feedings, presence of sepsis, and length of hospital stay. Live birth data for the province was obtained, and the incidence per 10,000 live births for 3 time intervals was calculated. Analysis was performed with mortality as the dependent variable. RESULTS: Seventy-one infants were identified. Overall survival rate was 93% (66 of 71). During the 3 time intervals examined, the incidence of gastroschisis per 10,000 live births increased from 1.85 in 1985 to 1990 to 3.66 in 1991 to 1995 to 4.06 in 1996 to 2000. The analysis found that intestinal atresia P =.009, OR = 18.3 (95%CI: 2.457-136) and intestinal necrosis P =.050, OR = 10.33 (95%CI: 1.32-80.68) were significantly associated with mortality. CONCLUSIONS: The incidence of gastroschisis is increasing. Intestinal atresia and the development of intestinal necrosis were associated with poor outcome. Patients who had these complications all had short bowel, and full feedings could not be established. They required continuation of total parenteral nutrition and experienced episodes of sepsis.

Birth Weight↗
PubMed2006

Sudden fetal death associated with both duodenal atresia and umbilical cord ulcer: a case report and review.

We encountered one case of duodenal atresia complicated by massive intrauterine hemorrhage due to the perforation of an umbilical cord ulceration (UCU). UCU is an extremely rare complication in the perinatal period. Although the prenatal diagnosis of upper intestinal atresia has been established, little is known about the association between UCU and upper intestinal atresia. In this article, we report our case, review past articles, and discuss the underlying pathophysiological mechanisms of the cause of an UCU. Given the characteristic sites of upper intestinal atresia, we speculate that regurgitation of gastric or intestinal juice into the amniotic fluid could be responsible for the development of UCU. We also believe that close observation is required for patients who have upper intestinal atresia.

Adult↗