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Total gastric replacement following gas bloat in a 21-month-old child
1The Royal Manchester Children's Hospital, Manchester, United Kingdom.
Insights
A jejunal pouch effectively replaced a child's stomach after gastric infarction, enabling full oral nutrition and improved growth. This surgical technique offers a safe and effective solution for pediatric gastric replacement.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Gastroesophageal reflux is common in infants, sometimes requiring surgical intervention like Nissen fundoplication.
- Complications such as gastric infarction can necessitate complex reconstructive procedures.
Observation:
- A 21-month-old child developed gastric infarction following a dislodged nasogastric tube after fundoplication.
- A 30-cm retrocolic, N-shaped, isoperistaltic jejunal pouch was created for gastric replacement.
Findings:
- The jejunal pouch facilitated complete oral nutrition within 8 months, with no dumping syndrome.
- The child's growth trajectory improved significantly, moving from the 10th to the 50th percentile by 18 months.
Implications:
- This jejunal pouch reconstruction is a safe and effective alternative for gastric replacement in pediatric patients.
- The Hays and Clark technique for jejunal pouch creation shows promise in managing severe gastrointestinal complications in children.
Abstract:
A 21-month-old child with a previously repaired left congenital diaphragmatic hernia underwent a 360 degrees 'loose-wrap' Nissen fundoplication for gastroesophageal reflux. Failure to replace the dislodged nasogastric tube on the 2nd night led to severe gas bloat and total gastric infarction. A 30-cm retrocolic, N-shaped, isoperistaltic jejunal pouch was constructed for gastric replacement. A pyloromyotomy ensured free emptying and a pouchostomy secured the pouch to the abdominal wall. At 8 months all nutrition was oral except for a biannual vitamin B12 injection, there was no dumping, and the pouchostomy was removed. By 18 months growth, originally along the 10th centile, was sustained at the 50th centile. Our early impression recommends a 30-cm retrocolic, isoperistaltic, N-shaped jejunal pouch similar to that of Hays and Clark as a safe and effective replacement for the stomach in children.