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The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn.

Bauman Z, Nanagas V - Case Rep Pediatr (2015)

Bottom Line: In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure.Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course.Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

View Article: PubMed Central - PubMed

Affiliation: Henry Ford Macomb Hospital, Clinton Township, MI 48038, USA.

ABSTRACT
We encountered a rare case of gastroschisis associated with jejunal atresia and colonic atresia. In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure. The colonic atresia was not discovered for 48 days after initial repair of the gastroschisis secondary to the rarity of the disorder. Both types of atresia were repaired with primary hand-sewn anastomoses. Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course. Based on our case presentation, small bowel atresia and colonic atresia must be considered in patients who undergo abdominal wall closure for gastroschisis with prolonged symptoms suggestive of bowel obstruction. Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

No MeSH data available.


Related in: MedlinePlus

Upper gastrointestinal small bowel follow-through showing no progression of contrast beyond the right side of the abdomen after 4 days suggestive of obstruction. Previous enteroenterostomy appears patent.
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fig3: Upper gastrointestinal small bowel follow-through showing no progression of contrast beyond the right side of the abdomen after 4 days suggestive of obstruction. Previous enteroenterostomy appears patent.

Mentions: Once again, the patient did well postoperatively. His TPN was continued and the nasogastric tube remained in place for decompression secondary to the anticipated postoperative ileus. Three weeks following the second surgery, there was again concern for an obstructive process, as the patient was still demonstrating high, nonbilious output from the nasogastric tube with chronic abdominal distension and no progression of bowel function. Furthermore, the patient also developed elevated bilirubin levels due to the extended period of time receiving TPN. At this point, we attributed the prolonged ileus to the previous two extensive surgeries experienced by the patient; however, in retrospect, we probably observed the patient too long this second time. The average postoperative ileus for jejunal atresia is approximately 5 days with a range of 3 to 10 days [10]. Additional imaging, such as an abdominal ultrasound, may have been beneficial during this time to help determine why the patient was not having bowel function. Nonetheless, a barium enema was obtained (Figure 2) after our allotted observation time demonstrating no progression of contrast beyond the midtransverse colon as well as significant microcolon, highly suggestive of colonic obstruction. Furthermore, an upper gastrointestinal study with small bowel follow-through was again performed (Figure 3). It demonstrated patency of the previously created jejunojejunostomy and propagation of contrast into the distal small bowel and proximal colon but was also suggestive of a distal colonic obstruction. Due to a work-up and clinical presentation highly suggestive of a colonic obstruction, the patient was taken back to the operating room on day of life 48 for a second exploratory laparotomy.


The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn.

Bauman Z, Nanagas V - Case Rep Pediatr (2015)

Upper gastrointestinal small bowel follow-through showing no progression of contrast beyond the right side of the abdomen after 4 days suggestive of obstruction. Previous enteroenterostomy appears patent.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4477220&req=5

fig3: Upper gastrointestinal small bowel follow-through showing no progression of contrast beyond the right side of the abdomen after 4 days suggestive of obstruction. Previous enteroenterostomy appears patent.
Mentions: Once again, the patient did well postoperatively. His TPN was continued and the nasogastric tube remained in place for decompression secondary to the anticipated postoperative ileus. Three weeks following the second surgery, there was again concern for an obstructive process, as the patient was still demonstrating high, nonbilious output from the nasogastric tube with chronic abdominal distension and no progression of bowel function. Furthermore, the patient also developed elevated bilirubin levels due to the extended period of time receiving TPN. At this point, we attributed the prolonged ileus to the previous two extensive surgeries experienced by the patient; however, in retrospect, we probably observed the patient too long this second time. The average postoperative ileus for jejunal atresia is approximately 5 days with a range of 3 to 10 days [10]. Additional imaging, such as an abdominal ultrasound, may have been beneficial during this time to help determine why the patient was not having bowel function. Nonetheless, a barium enema was obtained (Figure 2) after our allotted observation time demonstrating no progression of contrast beyond the midtransverse colon as well as significant microcolon, highly suggestive of colonic obstruction. Furthermore, an upper gastrointestinal study with small bowel follow-through was again performed (Figure 3). It demonstrated patency of the previously created jejunojejunostomy and propagation of contrast into the distal small bowel and proximal colon but was also suggestive of a distal colonic obstruction. Due to a work-up and clinical presentation highly suggestive of a colonic obstruction, the patient was taken back to the operating room on day of life 48 for a second exploratory laparotomy.

Bottom Line: In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure.Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course.Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

View Article: PubMed Central - PubMed

Affiliation: Henry Ford Macomb Hospital, Clinton Township, MI 48038, USA.

ABSTRACT
We encountered a rare case of gastroschisis associated with jejunal atresia and colonic atresia. In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure. The colonic atresia was not discovered for 48 days after initial repair of the gastroschisis secondary to the rarity of the disorder. Both types of atresia were repaired with primary hand-sewn anastomoses. Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course. Based on our case presentation, small bowel atresia and colonic atresia must be considered in patients who undergo abdominal wall closure for gastroschisis with prolonged symptoms suggestive of bowel obstruction. Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

No MeSH data available.


Related in: MedlinePlus