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Gastric infarction secondary to small bowel obstruction: a preventable complication after Nissen fundoplication
P L Glick1, M R Harrison, N S Adzick
1Department of Surgery, University of California, San Francisco.
Insights
Nissen fundoplication in infants can lead to severe complications like bowel obstruction due to inability to belch or vomit. Proper airway management during resuscitation is crucial to prevent gastric dilation and intestinal infarction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Complications
Background:
- Severe gastroesophageal reflux in infants often necessitates surgical intervention, such as Nissen fundoplication.
- Fundoplication aims to prevent reflux but can alter normal gastric function.
Observation:
- Two infants developed small bowel obstruction months after Nissen fundoplication.
- Complications arose from the inability to belch or vomit post-surgery.
- Inappropriate airway management during resuscitation exacerbated gastric dilation.
Findings:
- Massive gastric dilation occurred due to impaired belching/vomiting reflexes.
- This dilation led to infarction of the stomach, duodenum, and small intestines.
- Delayed diagnosis and management contributed to the severity of the outcome.
Implications:
- Highlights the critical need for vigilant monitoring of gastric volume in infants post-fundoplication.
- Emphasizes the importance of appropriate airway management and resuscitation techniques in surgical patients.
- Suggests that these severe complications are preventable with careful clinical practice and timely intervention.
Abstract:
Two infants who required a Nissen fundoplication for severe gastroesophageal reflux developed small bowel obstruction 5 and 21 months postoperatively. Their inability to belch or vomit, coupled with inappropriate airway management during resuscitation led to massive gastric dilation, and eventual infarction of their stomach, duodenum, and small intestines. These complications are preventable with appropriate management.