Organ-preserving principles of reconstructive surgery for type iv intestinal atresia in newborns
DOI:
https://doi.org/10.15574/PS.2020.66.21Keywords:
multiple intestinal atresia, longitudinal tapering enteroplasty, surgical treatment, infantAbstract
Small intestinal atresia is the most common cause of congenital intestinal obstruction in newborn children. Due to the development of neonatal surgery survival of patients with this pathology has improved significantly, especially with type I–IIIa atresia, however, surgical treatment of type IIIb–IV atresia remains a complex problem. First of all, it is laparotomy, resection and multiple anastomosing of obstructed small intestinal segments with Mikulich enterostomy. The postoperative course was complicated by the development of bacterial and fungal sepsis. In the inter-operative period, complete parenteral nutrition and mucous fistula refeeding were performed to maintain continuity of gastrointestinal passage. On the 36th day of life, the second stage of surgical management was performed: relaparotomy, viscerolysis with subhepatic abscess repair, longitudinal tapering enteroplasty with enteroenterostomy. Preservation of the total small intestinal length up to 50.0 cm was achieved by applying a combination of proximal longitudinal tapering enteroplasty and distal multiple anastomosing. The baby achieved enteral autonomy at the age of 10 months.Conclusions. Prevention of short bowel syndrome in infants with type IV intestinal atresia consists in adherence to organ-preserving principles of surgical treatment. To preserve the length of the small intestine, the most useful is the combination of techniques of appropriate proximal intestinal segment enteroplasty and distal multiple gut anastomosing.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the child’s parents was obtained from the studies.
No conflict of interest was declared by the authors.
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