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Multiple atresias in a low-birth-weight twin
1Surgical Services Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia.
Journal of Pediatric Surgery
|July 7, 1999
Summary
Multiple small bowel atresias in a premature twin were successfully treated with extensive resection and nine anastomoses. The neonate tolerated full oral feedings, demonstrating that maximal bowel length preservation is achievable in low-birth-weight infants.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Fetal medicine
Background:
- Monochorionic twinning poses risks for intestinal atresia due to vascular anastomoses and potential ischemic insults.
- Prenatal ultrasound is crucial for monitoring the development of intestinal atresia in fetuses.
Observation:
- A 31-week premature twin weighing 1,690 g presented with 16 small bowel atresias.
- Surgical resection of atresias and short intestinal segments (≤5 cm) resulted in nine primary anastomoses.
- This procedure preserved 75% (107 cm) of the initial small bowel length.
Findings:
- The low-birth-weight neonate tolerated multiple anastomoses, highlighting the functional benefits of maximal bowel length preservation.
- The time to achieve full oral feedings was independent of the number of anastomoses performed.
- While prenatal diagnosis is possible, the risks of extreme prematurity currently limit the benefits of early delivery for intestinal atresia.
Implications:
- Extensive intestinal resection and multiple anastomoses can be safely performed in low-birth-weight neonates, optimizing bowel length.
- Understanding the link between monochorionic twinning and intestinal atresia can improve risk assessment and monitoring.
- Further research is needed to determine if early delivery impacts the prognosis of multiple intestinal atresias.