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Gastrointestinal complications of gastroschisis
Insights
Late complications of gastroschisis, including gastroesophageal reflux and necrotizing enterocolitis, are emerging. Early detection and clinical-radiological cooperation are crucial for improving infant survival rates.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Infant mortality from gastroschisis has decreased due to surgical advances and improved care.
- Late complications following gastroschisis repair are becoming more apparent.
Purpose of the Study:
- To identify and characterize significant late gastrointestinal complications in infants with gastroschisis.
- To highlight the challenges in diagnosing these complications and emphasize the need for collaborative care.
Main Methods:
- Retrospective review of 30 infants treated for gastroschisis.
- Analysis of clinical presentations, barium studies for gastroesophageal reflux, and diagnosis of necrotizing enterocolitis.
Main Results:
- Significant gastroesophageal reflux was detected in 70% of infants with appropriate barium studies.
- Necrotizing enterocolitis occurred in 7 infants, with 4 cases involving perforation.
- Clinical symptoms of dysmotility and reflux can be confused; necrotizing enterocolitis presented deceptively benignly.
Conclusions:
- Gastroesophageal reflux and necrotizing enterocolitis are significant late complications of gastroschisis.
- Close collaboration between clinicians and radiologists is essential for accurate diagnosis.
- Increased awareness and prompt detection are key to improving outcomes for infants with gastroschisis.
Abstract:
The mortality of infants with gastroschisis has been reduced markedly in the last decade with the application of new surgical techniques, improved metabolic monitoring, and total parenteral nutrition. The late complications of repaired gastroschisis are now emerging. In this series of 30 infants with gastroschisis (20% mortality) significant gastroesophageal reflux was identified in seven of 10 infants with the appropriate barium study. The clinical symptom complexes of dysmotility, a recognized problem in gastroschisis, and gastroesophageal reflux can be easily confused. In addition, 11 episodes of necrotizing enterocolitis were identified in seven infants, four with perforations. The children with necrotizing enterocolitis had a deceptively benign clinical presentation, which was easily misinterpreted in these ill infants. Awareness of these two significant gastrointestinal complications and close cooperation of clinicians and radiologists to detect them should insure better survival in the infant with gastroschisis.