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Gastrointestinal complications of gastrocystoplasty
B D Gold1, P S Bhoopalam, R M Reifen
1Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Gastrocystoplasty, a stomach augmentation for bladder repair, led to significant gastrointestinal issues in children with chronic renal failure. Caution is advised due to these serious complications.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Nephrology
Background:
- Gastrocystoplasty involves augmenting the bladder with a vascularized stomach segment to create a neobladder.
- This procedure is used for various urological disorders, particularly in children with chronic renal failure.
Observation:
- Five children with chronic renal failure underwent gastrocystoplasty.
- Patients experienced significant gastrointestinal complications post-surgery.
Findings:
- All five patients had considerable weight loss; four showed failure to thrive.
- Two patients developed food aversion, feeding intolerance, dumping syndrome, delayed gastric emptying, and esophagitis.
- Three patients suffered severe abdominal pain and hemorrhagic cystitis due to gastric acid secretion from the neobladder.
Implications:
- The pathophysiology of these gastrointestinal complications requires further understanding.
- Cautious use of gastrocystoplasty in pediatric patients, especially those with chronic renal failure and uremia, is recommended pending long-term follow-up.
- Nutritional and pharmacological interventions are crucial for managing post-gastrocystoplasty gastrointestinal issues.
Abstract:
The cases are reported of five children with chronic renal failure who underwent gastrocystoplasty for a variety of urological disorders. Gastrocystoplasty comprises the transplantation of a vascularised segment of stomach to the bladder to form an augmented neobladder. The patients had gastrointestinal complications after the operation, including considerable weight loss in all five patients, accompanied by marked failure to thrive in four of the five patients, and food aversion, feeding intolerance, dumping syndrome, delayed gastric emptying, and oesophagitis in two patients. Three of the five patients developed severe abdominal pain and haemorrhagic cystitis secondary to gastric acid secretion in the neobladder from the transplanted gastric pedicle. Nutritional and pharmacological interventions were used to manage the gastrointestinal problems. Explanations are offered for the pathophysiology of the observed complications of gastrocystoplasty. It is believed that the use of this procedure in infants and children, particularly those with chronic renal failure and uraemia, warrants caution until successful long term follow up and experience with this procedure have been reported.