[Total gastrectomy in newborn infant]

Total gastrectomy is rarely indicated in childhood and when necessary it involves multiple ulterior therapeutic problems, mainly nutritional, which need a meticulous physiological approach to avoid further complications, as illustrated by the following patient who, at age 15 months, was submitted to total gastric resection, Y en Roux esophagojejunal anastomosis and splenectomy, because of peritonitis secondary to dehiscence of a recent esophagogastric anastomosis for partial gastric resection due to gastric volvulus and necrosis, which in turn were associated to diaphragmatic relaxation. The patient was admitted to our hospital one month later with signs of acute calorie-protein malnutrition (W/A 60% and W/H 68%, NCHS standards) requiring combined parenteral and enteral nutritional support (via central venous catheter and jejunostomy tube for 15 and 35 days respectively) together with intramuscular vitamin B 12, oral iron and oral vitamin supplements before it became possible to fed him only by mouth. Prophylaxis against Streptococcus pneumonia infections with monthly benzatin penicillin was also instituted. Mean daily weight increases of 16 g, W/A 68% and W/H 74% were thus achieved before hospital discharge, without evidence of dumping syndrome nor alkaline reflux.