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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
09:40

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Published on: April 17, 2020

Staple line ulcers: a cause of chronic GI bleeding following STEP procedure

Troy E Gibbons1, Helen B Casteel, Juliana F Vaughan

  • 1Gastroenterology, Hepatology and Nutrition, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock AR 72202, USA. GibbonsTroyE@uams.edu

Journal of Pediatric Surgery
|July 13, 2013
PubMed

Insights

Short bowel syndrome (SBS) can cause intestinal failure (IF) in children. In a patient treated with the Serial Transverse Enteroplasty (STEP) procedure for SBS, staple line ulcers were found to be the cause of gastrointestinal bleeding.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Surgical innovation

Background:

  • Intestinal failure (IF) is a critical reduction in functional intestinal mass, often necessitating total parenteral nutrition (TPN).
  • Short bowel syndrome (SBS) is the leading cause of IF in pediatric patients.
  • Small bowel adaptation post-resection involves elongation and dilation, which can lead to dysmotility and bacterial overgrowth, complicating feeding tolerance.

Observation:

  • Bowel lengthening procedures like Serial Transverse Enteroplasty (STEP) are indicated for significant small bowel dilation and inability to advance enteral feeds.
  • A case is presented of a pediatric patient with IF and SBS secondary to gastroschisis.
  • The patient developed anemia and occult gastrointestinal bleeding after undergoing the STEP procedure.

Findings:

  • Video capsule endoscopy (VCE) identified multiple ulcerations at surgical staple sites in the distal small intestine.
  • These staple line ulcerations were identified as the probable source of intestinal blood loss.

Implications:

  • This case highlights a potential complication of the STEP procedure, specifically staple line ulceration leading to bleeding.
  • It underscores the importance of VCE in diagnosing obscure gastrointestinal bleeding in pediatric SBS patients post-intervention.
  • Further research into optimizing surgical techniques and post-operative monitoring for STEP procedures may be warranted to mitigate bleeding risks.

Keywords:
Gastrointestinal bleedSerial Transverse enteroplasty procedureShort bowel syndromeVideo capsule endoscopy

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