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Gastroschisis complicated by intestinal atresia
Insights
Gastroschisis with intestinal discontinuity in infants can be successfully treated. Surgical repair of intestinal continuity, even after initial complications, leads to survival.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Surgery
Background:
- Gastroschisis is a congenital abdominal wall defect requiring surgical intervention.
- Associated intestinal injury, such as atresia or necrosis, complicates gastroschisis repair.
- Early management involves primary closure and decompression, with potential need for staged reconstruction.
Observation:
- Five infants with gastroschisis presented with loss of intestinal continuity within 4 years.
- These cases involved intestinal atresia or a gangrenous ileal segment.
- Initial management included gastroschisis closure, intestinal decompression, and either enterostomy or tube intubation.
Findings:
- Four infants underwent a second operation between 2 and 4 weeks of age to re-establish intestinal continuity.
- At reoperation, the previously matted intestine appeared normal with resolved edema and minimal adhesions.
- The initially perceived shortened intestine was found to be of adequate length for anastomosis.
Implications:
- Surgical repair of intestinal continuity in gastroschisis is feasible and successful.
- Accurate assessment of intestinal length is crucial and often underestimated at birth.
- Principles for repairing isolated neonatal intestinal atresia are applicable in these complex cases.
Abstract:
Five of 22 infants operated upon in the last 4 yr for gastroschisis had an associated loss of intestinal continuity. Four of the infants had an intestinal atresia and one had a gangrenous segment of ileum. Each had primary closure of the gastroschisis and decompression of the proximal intestine. Four had cutaneous enterostomy and one had long tube intubation. Four infants were returned to the operating room between 2 and 4 wk of age and their intestinal continuity was established. At the second operation the intestine, which had presented as a matted mass at birth, appeared normal with resolution of the serosal edema and few adhesions. The length of the intestine that initially had appeared shortened may be more accurately evaluated and is usually considerably greater than was appreciated at birth. If distal atresias are present, they will become apparent. A primary anastomosis can be carried out using the principles of repair for an isolated intestinal atresia in the newborn. All five of these infants have survived.