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Management of multiple jejunoileal atresias with an intraluminal SILASTIC stent
M S Chaet1, B W Warner, C A Sheldon
1Department of Surgery, University of Cincinnati College of Medicine, Children's Hospital Medical Center, OH 45229-3039.
Insights
A novel technique using a silicone catheter as an intraluminal stent facilitated multiple small bowel anastomoses in a neonate with 23 atresias. This approach enabled safe radiological evaluation and enteral feeding, leading to successful nutritional independence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Device Innovation
Background:
- Multiple small bowel atresias pose significant surgical challenges, necessitating maximal intestinal conservation for patient survival.
- Effective management strategies are crucial for improving outcomes in neonates with extensive intestinal malformations.
Observation:
- A case involving a neonate with 23 jejunal and ileal atresias was managed using a 7F SILASTIC catheter as an intraluminal stent.
- The catheter was utilized to facilitate multiple primary anastomoses, serve as a conduit for radiological assessment, and enable enteral feeding.
Findings:
- Seven primary anastomoses were successfully completed over the intraluminal catheter in a patient with extensive small bowel atresias.
- Post-operative radiological evaluation via the catheter confirmed no leaks or strictures, followed by its use for enteral nutrition.
- The patient achieved nutritional independence, discontinuing parenteral nutrition 31 months post-surgery.
Implications:
- This case highlights the safety and efficacy of employing an exteriorized intraluminal stent (silicone catheter) for complex multiple small bowel anastomoses.
- The technique offers a viable method for radiological evaluation and enteral access in challenging pediatric surgical cases.
- Successful long-term outcomes suggest potential for this approach in similar complex congenital gastrointestinal anomalies.
Abstract:
Multiple small bowel atresias present a unique challenge because maximum intestinal conservation is mandatory for survival. We recently treated a patient who had multiple atresias using a 7F SILASTIC catheter as an intraluminal stent. The catheter facilitated the completion of multiple primary anastomoses and served as a conduit for radiological evaluation and enteral feeding. The patient was a 1,860-g boy with 23 atresias of the jejunum and ileum. All stenotic segments were resected, and seven primary anastomoses were completed over the catheter. The distal 34 cm of bowel were exteriorized as a mucus fistula, with the catheter extending through to the level of the ileocecal valve. The proximal jejunal limb also was exteriorized. Eleven days later, contrast was instilled through the catheter and showed no leak or stricture. The catheter was then used for enteral nutrition and administration of the proximal jejunal effluent. Bowel continuity was reestablished after a tapering enteroplasty of the proximal jejunal limb. Parenteral nutrition was ultimately discontinued. Thirty-one months later, the patient no longer requires supplemental nutritional support. This case demonstrates the safety of multiple primary anastomoses over an exteriorized intraluminal stent. The catheter was useful in the radiological evaluation of the distal limb before it was used as an access route for enteral nutrition.