- The first experience in stapled longitudinal tapering enteroplasty in three month old child with ileal atresia in Ukraine
The first experience in stapled longitudinal tapering enteroplasty in three month old child with ileal atresia in Ukraine
PAEDIATRIC SURGERY.UKRAINE.2019.1(62):18-24; DOI 10.15574/PS.2019.62.18
Sliepov O., Wales P. W., Migur M., Ponomarenko O.
SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine», Kyiv
The Hospital for Sick Children, Toronto, Canada
Introduction. Dilation of proximal intestinal segment, in relation to atresia, not only creates difficulties in application of anastomosis, but also leads to disturbance of its peristaltic activity. Functional obstruction of this intestinal part is the cause of chronic malabsorption, small intestinal bacterial overgrowth and sepsis, which cannot be managed with non-surgical treatment.
Case report. The presence of jejuno-ileal obstruction in child was diagnosed prenatally. On the 3rd day of life laparotomy with resection of the proximal and distal blind ending ileum and end-to-end anastomosis were conducted. Postoperative course was complicated by partial intestinal obstruction. 20 days after the first operation, relaparotomy with adhesiolysis and appendicostomy were performed, to decompress the dilated proximal ileum a tube was placed in it through the appendicostomy above the anastomosis. After the tube displacement partial intestinal obstruction was restored. 22 days after the second operation repeated relaparotomy with resection of the anastomosis and Mikulicz’s enterostomy were performed. For further treatment at the age of 2 months the child was referred to the department of surgical correction of birth defects in children at the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine». The enterostomy closure with end-to-side anastomosis were performed. To resolve the functional intestinal obstruction stapled longitudinal tapering enteroplasty of dilated ileum was utilized. Thus, conducted surgical management allowed restoring the normal intestinal passage and reaching of complete enteral feeding.
Conclusion. Stapled longitudinal tapering enteroplasty is the feasible surgical approach to management of intestinal dilatation and its functional obstruction in intestinal atresia, is associated with enhanced functional results along with operation time reduction and can be safely utilized in children.
Key words: intestinal atresia, longitudinal tapering enteroplasty, stapled enteroplasty, surgical treatment.
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Article received: Nov 21, 2018. Accepted for publication: Mar 09, 2019.