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Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity.
J Pediatr Surg. 2008 Dec; 43(12):2208-12.JP

Abstract

PURPOSE

Intestinal atresia (IA) occurs in 10% to 20% of infants born with gastroschisis (GS). We describe a distinct subset of these children with severe dysmotility, without mechanical intestinal obstruction, and with adequate intestinal length for enteral nutrition and propose possible treatment strategies.

METHODS

A total of 177 patients with GS managed at a single institution between 1993 and 2007 were retrospectively reviewed.

RESULTS

Twenty-one (12%) patients had IA. Six (29%) did well, with gradual progression to full diet; 1 died at birth because of complete midgut infarction; 1 died of necrotizing enterocolitis; 4 with short bowel syndrome (SBS) (small bowel length, 30-41 cm) died of liver failure because of total parenteral nutrition (3) or sepsis (1). Nine (43%) were felt to have gastroschisis/atresia/dysmotility, defined as adequate small bowel length for survival as measured at time of laparotomy (mean, 146 cm; range, 66-233 cm), massive intestinal dilatation, and stasis. Of 9 patients with gastroschisis/atresia/dysmotility, 5 (56%) survived. All had surgery to "rescue" their dysfunction intestine, at mean age 128 days (range, 52-271 days): 4 had tapering enteroplasties of mean 37 cm (range, 5-115 cm)-all 4 survived; 3 had diverting stomas created for intestinal decompression, followed by stoma closure-1 survived; 1 nonsurvivor had a Kimura "patch"; 1 nonsurvivor underwent redo anastomosis. Survivors weaned off total parenteral nutrition at mean age 331 days after rescue surgery (range, 42-814 days).

CONCLUSIONS

More than one third of patients with GS/IA appear to have significant intestinal dysmotility without true SBS nor obstruction. Successful treatment of these infants may be achieved with the use of tapering enteroplasty and/or temporary diverting stomas.

Authors+Show Affiliations

Division of Pediatric Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. duncan_phillips@med.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19040936

Citation

Phillips, J Duncan, et al. "Gastroschisis, Atresia, Dysmotility: Surgical Treatment Strategies for a Distinct Clinical Entity." Journal of Pediatric Surgery, vol. 43, no. 12, 2008, pp. 2208-12.
Phillips JD, Raval MV, Redden C, et al. Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. J Pediatr Surg. 2008;43(12):2208-12.
Phillips, J. D., Raval, M. V., Redden, C., & Weiner, T. M. (2008). Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. Journal of Pediatric Surgery, 43(12), 2208-12. https://doi.org/10.1016/j.jpedsurg.2008.08.065
Phillips JD, et al. Gastroschisis, Atresia, Dysmotility: Surgical Treatment Strategies for a Distinct Clinical Entity. J Pediatr Surg. 2008;43(12):2208-12. PubMed PMID: 19040936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. AU - Phillips,J Duncan, AU - Raval,Mehul V, AU - Redden,Courtney, AU - Weiner,Timothy M, PY - 2008/08/26/received PY - 2008/08/29/accepted PY - 2008/12/2/pubmed PY - 2009/3/26/medline PY - 2008/12/2/entrez SP - 2208 EP - 12 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 43 IS - 12 N2 - PURPOSE: Intestinal atresia (IA) occurs in 10% to 20% of infants born with gastroschisis (GS). We describe a distinct subset of these children with severe dysmotility, without mechanical intestinal obstruction, and with adequate intestinal length for enteral nutrition and propose possible treatment strategies. METHODS: A total of 177 patients with GS managed at a single institution between 1993 and 2007 were retrospectively reviewed. RESULTS: Twenty-one (12%) patients had IA. Six (29%) did well, with gradual progression to full diet; 1 died at birth because of complete midgut infarction; 1 died of necrotizing enterocolitis; 4 with short bowel syndrome (SBS) (small bowel length, 30-41 cm) died of liver failure because of total parenteral nutrition (3) or sepsis (1). Nine (43%) were felt to have gastroschisis/atresia/dysmotility, defined as adequate small bowel length for survival as measured at time of laparotomy (mean, 146 cm; range, 66-233 cm), massive intestinal dilatation, and stasis. Of 9 patients with gastroschisis/atresia/dysmotility, 5 (56%) survived. All had surgery to "rescue" their dysfunction intestine, at mean age 128 days (range, 52-271 days): 4 had tapering enteroplasties of mean 37 cm (range, 5-115 cm)-all 4 survived; 3 had diverting stomas created for intestinal decompression, followed by stoma closure-1 survived; 1 nonsurvivor had a Kimura "patch"; 1 nonsurvivor underwent redo anastomosis. Survivors weaned off total parenteral nutrition at mean age 331 days after rescue surgery (range, 42-814 days). CONCLUSIONS: More than one third of patients with GS/IA appear to have significant intestinal dysmotility without true SBS nor obstruction. Successful treatment of these infants may be achieved with the use of tapering enteroplasty and/or temporary diverting stomas. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/19040936/Gastroschisis_atresia_dysmotility:_surgical_treatment_strategies_for_a_distinct_clinical_entity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(08)00764-1 DB - PRIME DP - Unbound Medicine ER -