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Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome: A
1Department of Neonatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China.
Insights
Congenital intestinal malrotation (CIM) with gastric wall defect is a severe condition. This case shows that prolonged treatment after surgery can improve outcomes for neonates with extensive gut necrosis and short gut syndrome.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Gastroenterology
Background:
- Congenital intestinal malrotation (CIM) is a frequent neonatal anomaly.
- CIM combined with a congenital gastric wall defect presents a critical surgical challenge.
- Early diagnosis and intervention are crucial for improving prognosis in neonates with CIM.
Observation:
- A neonate presented with bloody stools, vomiting, and abdominal distention.
- Exploratory laparotomy revealed intestinal malrotation with volvulus and a significant gastric wall defect with perforation.
- The neonate developed extensive gut necrosis and short gut syndrome.
Findings:
- Surgical repair included Ladd's procedure for malrotation and gastric wall defect repair.
- Multiple surgeries were required, including adhesiolysis and resection of necrotic bowel.
- The neonate survived and demonstrated normal growth and development post-treatment.
Implications:
- This case underscores the potential for intestinal salvage through prolonged medical management post-necrotic bowel resection.
- Aggressive surgical and medical strategies can lead to favorable outcomes in complex neonatal surgical cases.
- Successful management of CIM with gastric wall defects can improve long-term patient prognosis.
Background:
Congenital intestinal malrotation (CIM) is a common malformation in neonates. Early diagnosis and surgical intervention can improve the prognosis. CIM combined with congenital gastric wall defect is a potentially fatal condition. We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome. After three operations, the neonate survived and subsequently showed normal growth and development during infancy.
Case Summary:
A male neonate (age: 4 d) was hospitalized due to bloody stools and vomiting for 2 d, and abdominal distention for 1 d. Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops. Bowel alignment was abnormal with congestion and dilatation of the entire intestine, and clockwise mesentery volvulus (720°). The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer (approximately 5.5 cm), and a circular perforation (approximately 3 cm diameter) at the center of this defect. Ladd's procedure was performed and gastric wall defect was repaired. Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum, and adhesion angulated between many small intestinal loops. We performed intestinal adhesiolysis, resection of necrotic intestine, and small bowel anastomosis.
Conclusion:
This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines, and improve patient prognosis.
