• Staged surgical management of gastroschisis with severe viscero-abdominal disproportion complicated by membranous intestinal obstruction 

Staged surgical management of gastroschisis with severe viscero-abdominal disproportion complicated by membranous intestinal obstruction 

PERINATOLOGIYA I PEDIATRIYA. 2016.4(68):55-59; doi 10.15574/PP.2016.68.55 
 

Staged surgical management of gastroschisis with severe viscero-abdominal disproportion complicated by membranous intestinal obstruction 
 

Sliepov O., Gordienko I., Migur M., Tarapurova H., Ponomarenko O., Soroka V., Markevich H.

SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv


Introduction. Incidence of gastroschisis (GS) complicated by intestinal atresia is 4.5–12.6% of cases. 80% of this obstructions are observed in jejunoileal segment. Association of GS with intestinal atresia (GIA) is usually diagnosed well, but at birth, diagnosis of atresia is often controversial. There is misdiagnosis of atresia during the initial surgery in about 12% of cases. The ideal treatment model of GIA had not already been set. Different surgical approaches were described in literature: abdominal closure modalities, terms of intestinal anastomoses creation and intestinal stomas formation remain outstanding issues. the severity of congenital defects may vary thus the tactics and strategy of surgical management as well as the ability to create primary intestinal anastomosis should be considered individually.


Clinical case. GS with severe viscero-abdominal disproportion (VAD) in fetus was diagnosed prenatally by ultrasonography (US) at 21 week of gestation. Prenatal US follow-up monitoring and examinations were conducted. The presence of concomitant intestinal obstruction was suspected at 35 week of gestation. Regarding diagnosed malformations, according to developed in our clinic "First Minutes Surgery" tactics, operation was performed in 15 minutes after birth. During the initial surgery intestinal obstruction was not confirmed. Staged surgical management of GS was conducted. Intestinal obstruction was diagnosed and confirmed by radiography only after 21 days of age, after increasing of oral intakes volume to 15.0 ml. Jejunal web was found on surgery. Following web removal diamond-shaped anastomosis was created. During post-op period the recurrence of intestinal obstruction was not observed, full enteral nutrition was reached. The good outcome after exhibited surgical management was achieved.


Conclusions. The proposed strategy and tactics of surgical management found to be effective and can be applied in the case of GS with severe VAD complicated by jejunal atresia type I.


Key words: gastroschisis, jejunal web, surgical management, newborn baby.


References

1. Sliepov AK, Grasyukova NI, Veselskiy VL. 2014. The results of the «first minutes surgery» in the treatment of gastroschisis. Perinatologiya i pediatriya. 4: 18—23.

2. Ohno K, Nakamura T, Azuma T et al. 2009. Catheter enterostomy and patch repair of the abdominal wall for gastroschisis with intestinal atresia: report of a case. Surg Today. 39(8): 725-727. https://doi.org/10.1007/s00595-008-3986-1; PMid:19639444

3. Fleet MS, de la Hunt MN. 2000. Intestinal atresia with gastroschisis: a selective approach to management. J Pediatr Surg. 35: 1323—1325. https://doi.org/10.1053/jpsu.2000.9324; PMid:10999689

4. Abdullah F, Amold MA, Nabaweesi R et al. 2007. Gastroschisis in the United States 1988-2003: analysis and risk catego-rization of 4344 patients. J Perinatol. 27: 50—55. https://doi.org/10.1038/sj.jp.7211616; PMid:17036030

5. Phillips JD, Raval MV, Redden C et al. 2008. Gastroschisis, atresia, dysmotility: surgical treatment strategies for a distinct clinical entity. J Pediatr Surg. 43(12): 2208-2212. https://doi.org/10.1016/j.jpedsurg.2008.08.065; PMid:19040936

6. Holcomb GW III, Ostlie DJ. 2014. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia: Еlsevier saunders: 1040.

7. Hoehner JC, Ein SH, Kim PCW. 1998. Management of gastroschisis with concomitant jejuni-ilealatresia. J Pediatr Surg. 33: 885—888. https://doi.org/10.1016/S0022-3468(98)90666-2

8. Kronfli R, Bradnock TJ, Sabharwa A. 2010. Intestinal atresia in association with gastroschisis: a 26-year review. Pediatr Surg Int. 26: 891—894. https://doi.org/10.1007/s00383-010-2676-4; PMid:20676892

9. Snyder CL, Miller KA, Sharp RJ et al. 2001. Management of intestinal atresia in patients with gastroschisis. J Pediatr Surg. 36: 1542—1545. https://doi.org/10.1053/jpsu.2001.27040; PMid:11584405