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Second serial transverse enteroplasty procedure in an infant with extreme short bowel syndrome.

Oh JT, Koh H, Chang EY, Chang HK, Han SJ - J. Korean Med. Sci. (2012)

Bottom Line: The advantages of STEP include not only technical ease and simplicity, but also the ability to repeat the procedure.A 3-day old newborn girl underwent STEP because of jejunal atresia with the small bowel length of 15 cm, but her bowel elongation was not enough to escape from short bowel syndrome.At the age of 6 months, she underwent a second STEP procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea. jtoh@yuhs.ac

ABSTRACT
The serial transverse enteroplasty (STEP) procedure is a novel technique to lengthen and taper the bowel in patients with short bowel syndrome. The advantages of STEP include not only technical ease and simplicity, but also the ability to repeat the procedure. Herein, we report a case of extreme short bowel syndrome that was successfully treated by the second STEP procedure. A 3-day old newborn girl underwent STEP because of jejunal atresia with the small bowel length of 15 cm, but her bowel elongation was not enough to escape from short bowel syndrome. At the age of 6 months, she underwent a second STEP procedure. The bowel lengthening by the second STEP made her tolerable to enteral feeding with body weight gain and rescued her from short bowel syndrome. This case showed that second STEP is very helpful in treatment of extreme short bowel syndrome.

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Related in: MedlinePlus

Schematic illustration of the first STEP. (A) Preoperative and (B) postoperative bowel appearance and length.
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Figure 2: Schematic illustration of the first STEP. (A) Preoperative and (B) postoperative bowel appearance and length.

Mentions: A 2.63-kg, 36-week gestation female neonate was born by elective cesarean delivery. At the third day of life, she underwent laparotomy and high jejunal atresia was found (Fig. 1). The proximal bowel was only 10 cm in length from the Treitz ligament with dilatation, and the distal bowel was 5 cm in length from the ileocecal valve. STEP was performed using 6 Endo GIA staplers on the proximal small bowel that resulted in an increase in intestinal length from 10 cm to 15 cm. The entire small bowel length was 20 cm after primary anastomosis with the distal small bowel (Fig. 2). Postoperatively, parenteral nutrition was discontinued because of cholestatic jaundice, but she was able to gain weight very slowly by enteral feeding, even though she needed intravenous electrolyte solution to prevent dehydration. By 6 months of age, the patient's body weight had increased to 3.71 kg, but she still required intravenous electrolyte solution and her small bowel was dilated again. As a result, we decided to perform the second STEP. The patient had relatively even dilatation of the small bowel with 4-5 cm in width. The previous proximal small bowel had gained length, from 15 cm to 30 cm, and the distal small bowel had grown from 5 cm to 12 cm. The second STEP was performed using 5 Endo GIA staplers on the previous proximal small bowel that resulted in an increase in intestinal length from 30 cm to 45 cm. The entire small bowel length was 57 cm (Fig. 3). After the second STEP procedure, the patient was tolerable to enteral feeding with body weight gain. At 8 months of age (2 months after the second STEP), her body weight was 4.41 kg after weaning the intravenous fluid, and she was discharged from the hospital. At the age of 2 yr, she has shown good growth and her body weight has increased to 9.8 kg, although her body weight is still in the low percentile of the growth chart (4th percentile) and she has developed vitamin D deficiency.


Second serial transverse enteroplasty procedure in an infant with extreme short bowel syndrome.

Oh JT, Koh H, Chang EY, Chang HK, Han SJ - J. Korean Med. Sci. (2012)

Schematic illustration of the first STEP. (A) Preoperative and (B) postoperative bowel appearance and length.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369460&req=5

Figure 2: Schematic illustration of the first STEP. (A) Preoperative and (B) postoperative bowel appearance and length.
Mentions: A 2.63-kg, 36-week gestation female neonate was born by elective cesarean delivery. At the third day of life, she underwent laparotomy and high jejunal atresia was found (Fig. 1). The proximal bowel was only 10 cm in length from the Treitz ligament with dilatation, and the distal bowel was 5 cm in length from the ileocecal valve. STEP was performed using 6 Endo GIA staplers on the proximal small bowel that resulted in an increase in intestinal length from 10 cm to 15 cm. The entire small bowel length was 20 cm after primary anastomosis with the distal small bowel (Fig. 2). Postoperatively, parenteral nutrition was discontinued because of cholestatic jaundice, but she was able to gain weight very slowly by enteral feeding, even though she needed intravenous electrolyte solution to prevent dehydration. By 6 months of age, the patient's body weight had increased to 3.71 kg, but she still required intravenous electrolyte solution and her small bowel was dilated again. As a result, we decided to perform the second STEP. The patient had relatively even dilatation of the small bowel with 4-5 cm in width. The previous proximal small bowel had gained length, from 15 cm to 30 cm, and the distal small bowel had grown from 5 cm to 12 cm. The second STEP was performed using 5 Endo GIA staplers on the previous proximal small bowel that resulted in an increase in intestinal length from 30 cm to 45 cm. The entire small bowel length was 57 cm (Fig. 3). After the second STEP procedure, the patient was tolerable to enteral feeding with body weight gain. At 8 months of age (2 months after the second STEP), her body weight was 4.41 kg after weaning the intravenous fluid, and she was discharged from the hospital. At the age of 2 yr, she has shown good growth and her body weight has increased to 9.8 kg, although her body weight is still in the low percentile of the growth chart (4th percentile) and she has developed vitamin D deficiency.

Bottom Line: The advantages of STEP include not only technical ease and simplicity, but also the ability to repeat the procedure.A 3-day old newborn girl underwent STEP because of jejunal atresia with the small bowel length of 15 cm, but her bowel elongation was not enough to escape from short bowel syndrome.At the age of 6 months, she underwent a second STEP procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea. jtoh@yuhs.ac

ABSTRACT
The serial transverse enteroplasty (STEP) procedure is a novel technique to lengthen and taper the bowel in patients with short bowel syndrome. The advantages of STEP include not only technical ease and simplicity, but also the ability to repeat the procedure. Herein, we report a case of extreme short bowel syndrome that was successfully treated by the second STEP procedure. A 3-day old newborn girl underwent STEP because of jejunal atresia with the small bowel length of 15 cm, but her bowel elongation was not enough to escape from short bowel syndrome. At the age of 6 months, she underwent a second STEP procedure. The bowel lengthening by the second STEP made her tolerable to enteral feeding with body weight gain and rescued her from short bowel syndrome. This case showed that second STEP is very helpful in treatment of extreme short bowel syndrome.

Show MeSH
Related in: MedlinePlus