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Intestinal atresia with gastroschisis: A selective approach to management

Lookup NU author(s): Michael De La Hunt

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Abstract

Background: The association of bowel atresia with gastroschisis is well recognized, but the ideal management is less certain. Methods: The records of 10 infants with gastroschisis acid intestinal atresia treated between 1991 and 1997 in a single neonatal surgical unit were reviewed. Results: Ten infants had midgut atresias: 5 small intestine, 1 jejunum and colon, and 4 colonic. Of the 6 with small bowel atresias, 4 had primary abdominal wall repair with electively delayed primary anastomosis at 21 to 46 days, 1 had decompressing tube jejunostomy at 11 days at the time of secondary abdominal closure, and 1 initial jejunostomy. Of the 4 with colonic atresia alone, 3 had perforation or infarction of the proximal colon at birth, 2 had a primary stoma, and 2, who did not have initial colostomy or anastomosis, required reoperation for increasing abdominal distension at 11 and 23 days. Complications were recorded in 6 patients: 2 had necrotizing enterocolitis after which 1 developed malabsorption, 1 had distal bowel obstruction after delayed primary anastomosis treated with a Bishop-Koop ileostomy at 50 days, 2 had stoma stenosis, and 1 had stoma prolapse. None died, and at 1 year 9 were within the normal range for body weight, and details of 1 are not known. Conclusions: At birth, diagnosis of atresia often is uncertain, and the bower is difficult to repair or exteriorize. For proximal atresias, delayed primary repair is a safe satisfactory approach. At birth, distal atresias are more obvious, often complicated by perforation or infarction, and may benefit from early enterostomy. J Pediatr Surg 35:1323-1325. Copyright (C) 2000 by W.B. Saunders Company.

Publication metadata

Author(s): Fleet MS, de la Hunt MN

Publication type: Article

Publication status: Published

Journal: Journal of Pediatric Surgery

Year: 2000

Volume: 35

Issue: 9

Pages: 1323-1325

ISSN (print): 0022-3468

ISSN (electronic): 1531-5037

Publisher: W.B. Saunders Co. Ltd.

URL: .http:/dx.doi.org/10.1053/jpsu.2000.9324

DOI: 10.1053/jpsu.2000.9324

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