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Surgical management of chronic intestinal pseudo-obstruction in infancy and childhood
E W Fonkalsrud1, H A Pitt, W E Berquist
1Department of Surgery, UCLA School of Medicine 90024.
Insights
Chronic intestinal pseudo-obstruction in children is challenging. Combining total parenteral nutrition (TPN) with venting gastrostomy significantly reduced hospitalizations and surgeries for these patients.
Area of Science:
- Pediatric Gastroenterology
- Surgical Management
- Nutritional Support
Background:
- Chronic intestinal pseudo-obstruction (CIPO) is a rare pediatric condition.
- CIPO causes repeated bowel obstructions of unknown origin.
- It often necessitates multiple surgeries and can be fatal.
Purpose of the Study:
- To evaluate the efficacy of total parenteral nutrition (TPN) combined with venting gastrostomy in managing pediatric CIPO.
- To assess the impact of this combined approach on hospitalizations and surgical interventions.
Main Methods:
- Retrospective analysis of 17 pediatric patients with CIPO.
- Implementation of TPN and venting gastrostomy as primary management.
- Comparison of outcomes before and after routine use of these techniques.
Main Results:
- A sixfold reduction in hospitalizations was observed.
- A tenfold decrease in laparotomies for obstruction occurred.
- Sufficient caloric intake for growth was achieved.
Conclusions:
- TPN combined with venting gastrostomy is an effective strategy for managing pediatric CIPO.
- This approach significantly minimizes surgical procedures and hospitalizations.
- Encouraging oral intake remains important alongside nutritional support.
Abstract:
Chronic intestinal pseudo-obstruction is an uncommon cause of repeated obstruction in children of undetermined etiology, often leading to repeated laparotomies and early death. TPN combined with venting gastrostomy provides sufficient calories for growth and minimizes the need for operations and/or hospitalizations. Seventeen children managed with these techniques experienced a sixfold decrease in the number of hospitalizations, and more than a tenfold decrease in the number of laparotomies for obstruction compared to the period before routine use of TPN and gastrostomies. Oral feedings are encouraged whenever possible.