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Ischemic bowel after primary closure for gastroschisis
S H Ein1, R Superina, C Bagwell
1Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Journal of Pediatric Surgery
|August 1, 1988
Summary
Four newborns with gastroschisis developed ischemic bowel after primary closure. Prompt reoperation is crucial if acidosis, sepsis, or worsening condition persist post-surgery to prevent necrotic bowel.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Gastroschisis is a congenital defect where intestines protrude outside the abdomen.
- Primary closure is a surgical technique to repair gastroschisis.
- Postoperative complications can arise, necessitating careful monitoring.
Observation:
- Four neonates undergoing primary gastroschisis repair experienced postoperative ischemic bowel between 1983-1986.
- Clinical signs included persistent acidosis, sepsis, abdominal wall redness, and general deterioration.
- All four infants required re-exploration due to suspected intra-abdominal complications.
Findings:
- Necrotic bowel was identified in all re-explored neonates.
- Three infants required silon pouch closure for necrotic bowel.
- Two surviving infants were left with temporary short bowel syndrome.
Implications:
- Excessive intra-abdominal pressure, volvulus, or aggressive bowel manipulation during primary closure may contribute to ischemia.
- Vigorous manipulation and compression of gastroschisis contents should be avoided.
- Immediate reoperation and decompression are indicated for newborns exhibiting signs of postoperative compromise after gastroschisis repair.