Approximative Intestinal Anastomosis in newborns with Multifocal Necrotizing Enterocolitis

Česká verzia

Authors: M. Rygl; R. Škába; K. Pýcha; J. Kučera ^*; Z. Straňák ^*
Authors place of work: Klinika dětské chirurgie UK Praha, 2. LF a FN Motol, Katedra dětské chirurgie IPVZ, Praha přednosta: prof. MUDr. J. Šnajdauf, DrSc. ; Ústav pro péči o matku a dítě, Podolí, Katedra gynekologie a porodnictví IPVZ, Praha přednosta: doc. MUDr. J. Feyereisl, CSc. ^*
Published in the journal: Rozhl. Chir., 2007, roč. 86, č. 8, s. 415-419.
Category: Monothematic special - Original

Summary

Multifocal necrotizing enterocolitis (NEC) may result in extensive bowel necrosis and short bowel syndrome. Authors present case report of premature newborn (BW 1700 g, gestational age 30 w.) where an extensive multisegmental NEC of small and large intestine was found during first explorative laparotomy. Proximal jejunostomy 28 cm beyond ligament of Treitz was performed and the rest of involved intestine was left in situ. After 48 hours multiple small bowel resections were performed leaving 12 cm of small intestine (5 short segments) distal to the jejunostomy. Five approximative anastomoses were performed to restore continuity among these segments and ileocaecal valve. Each of approximative anastomosis was constructed with limited number of 4–6 interrupted stitches and all anastomoses healed without complication. Intestinal continuity between proximal jejunostomy and the reconstructed segment of ileum was re-established nine weeks later. Total length of small bowel was 50 cm. The patient was discharged at the age of 5 months weighing 4145 g with supplemental pareneteral nutrition. The technique of rapid approximative anastomosis may contribute to save maximal intestinal length in cases with the risk of short bowel syndrome.

Key words:
necrotizing enterocolitis – short bowel syndrome – approximative anastomosis

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