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1.
Rev Colomb Obstet Ginecol ; 72(2): 202-209, 2021 Jun 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34506706

RESUMO

Objectives: To report the case of a patient with a prenatal diagnosis of jejunal atresia and to review the literature regarding the results and prenatal diagnosis of this entity, implementing the use of non-conventional methods (3D ultrasound or magnetic resonance imaging). Material and methods: Report of a case of an 18-year-old pregnant woman referred to the Maternal-Fetal Medicine, Genetics and Reproduction Unit of the Virgen del Rocío Hospital in Seville due to fetus with abdominal peristaltic cystic image, consistent with jejunal atresia, confirmed with 3D HDLive mode ultrasound. A bibliographic search was carried out in Medline/PubMed, Google Scholar and LILACS, restricting by type of language (English and Spanish) and date of publication (January 1995 to June 2020). Primary studies of reports and case series relating to the outcome and prenatal diagnosis of this pathology were included. Results: The search identified 1,033 titles, of which four studies met the inclusion criteria, these being reports or case series. A total of twelve fetuses with a prenatal diagnosis of jejunal atresia detected with unconventional methods were reported. In all cases, the prenatal diagnosis was confirmed during the neonatal period, which required resection of the compromised segment; one of them died and two neonates developed short bowel syndrome because of a wide bowel resection. The postoperative course in the remaining cases was favorable. Conclusion: The available literature on the prenatal diagnosis of jejunal atresia using non-conventional methods is scarce and is limited to case reports or case series. The literature reviewed suggests that, in the presence of intestinal dilation, 3D ultrasound and magnetic resonance imaging could be of some use in characterizing the atretic portion and establishing the differential diagnosis. More studies are required to evaluate the diagnostic utility of these two alternatives.


Assuntos
Atresia Intestinal , Adolescente , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/cirurgia , Imageamento por Ressonância Magnética , Gravidez , Diagnóstico Pré-Natal , Ultrassonografia , Ultrassonografia Pré-Natal
2.
J Laparoendosc Adv Surg Tech A ; 31(10): 1185-1194, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34357817

RESUMO

Background: Congenital intestinal obstruction occurs in ∼1:2000 live births. Congenital duodenal atresia and duodenal stenosis are frequent causes of intestinal obstruction and occur in 1 per 5000-10,000 live births. Today, duodeno-duodeno anastomosis is still the treatment of choice, and it can be performed safely by minimally invasive surgery, although duodenojejunal anastomosis is surgically simpler and has equal results. Jejunum-ileal atresia or stenosis is a major cause of neonatal intestinal obstruction; its prevalence is 1:330-1:1500 live births. Nowadays, the ability of laparoscopic assisted identification of the atresia and repair by only exteriorization of the small bowel through the umbilicus makes this technique safe and feasible in almost every new born. Methods: This article will describe the operative technique of laparoscopic management of congenital duodenal and small bowel obstruction. Results: For congenital duodenal atresia patients, mortality rate is less than 5% and the majority are secondary to associated comorbidities. There is a low rate of anastomotic leaks, anastomotic stricture, delayed gastric emptying, and bacterial overgrowth. For small bowel atresia patients, complications include anastomotic leak, adhesions, small bowel obstruction, and short bowel syndrome in less than 5% of the patients. The rate of re-operations due to small bowel obstruction in laparoscopic assisted repair patients is less compared with laparotomy patients. Conclusions: Minimally invasive surgery for duodenal and small bowel atresia is safe and feasible and reduces the complications of open surgical procedures.


Assuntos
Obstrução Duodenal , Atresia Intestinal , Obstrução Intestinal , Laparoscopia , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Humanos , Recém-Nascido , Atresia Intestinal/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado
3.
J Pediatr Gastroenterol Nutr ; 73(4): 560-565, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34238829

RESUMO

OBJECTIVES: To compare institutional practice patterns for gastrostomy tube placement in neonates with duodenal atresia (DA) and trisomy 21. METHODS: A retrospective review of the Pediatric Health Information System (PHIS) from 2015 to 2018 identified infants <10 days old with ICD-10 diagnostic codes for DA and trisomy 21, in addition to procedure codes for an intestinal bypass or duodenoduodenostomy. This cohort was then queried for gastrostomy tube procedure codes and diagnostic codes for associated co-morbidities. RESULTS: Two hundred and nine infants were identified with DA, trisomy 21, and an intestinal bypass. Fifty-seven (27%) underwent gastrostomy placement. Baseline characteristics of those with and without gastrostomy tubes were similar. Patients from 16 hospitals that placed no gastrostomy tubes (No-G-tube-Hospitals) were compared to children from 30 hospitals that placed at least one gastrostomy tube (G-tube-Hospitals). Open atresia repairs occurred more frequently at G-tube-Hospitals, but patients were otherwise similar. There was no difference in readmission at 12 months for gastrostomy placement between children from No-G-tube-Hospitals and those from G-tube-Hospitals that did not undergo gastrostomy during their index admission. CONCLUSIONS: One-third of institutions in this study did not place gastrostomy tubes during index admissions for neonates with trisomy 21 and DA, yet this did not negatively impact the length of stay or incidence of subsequent gastrostomy placement as a result. Future research is needed to determine factors that predispose patients to failure without gastrostomy, as well as best practices for post-operative management in these patients to reduce unnecessary tube placement.


Assuntos
Síndrome de Down , Atresia Intestinal , Intubação , Síndrome de Down/complicações , Obstrução Duodenal , Gastrostomia , Humanos , Lactente , Recém-Nascido , Atresia Intestinal/cirurgia , Estudos Retrospectivos
4.
J Coll Physicians Surg Pak ; 30(6): 740-742, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34102795

RESUMO

Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates.  About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.


Assuntos
Anormalidades do Sistema Digestório , Atresia Intestinal , Obstrução Intestinal , Anastomose Cirúrgica , Humanos , Recém-Nascido , Atresia Intestinal/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia
5.
J Med Case Rep ; 15(1): 239, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33941251

RESUMO

BACKGROUND: Intrauterine midgut volvulus is a very rare, life-threatening condition, and prenatal diagnosis is difficult. In this article, we present a case of midgut volvulus followed by a pre-diagnosis of antenatal jejunal atresia. CASE PRESENTATION: A 1-day-old Turkish male baby, who was followed with a diagnosis of antenatal jejunal atresia, with a birth weight of 3600 g, delivered by cesarean section at 38 weeks of gestation from a 19-year-old mother in her fourth pregnancy, was taken to the newborn intensive care unit. The patient underwent surgery on the postnatal first day with a preliminary diagnosis of jejunal atresia. It was observed that the small intestine was rotated two full cycles from the mesenteric root. Bowel blood circulation was good. Volvulus was untwisted. There was malrotation. Ladd's procedure was performed. The baby was discharged on the seventh postoperative day with full oral feeding. The patient is still in the first postoperative year and follow-up has been uneventful. CONCLUSION: Intrauterine midgut volvulus has been associated with high mortality in the literature. Differential diagnosis of midgut volvulus in patients with antenatal intestinal obstruction, close prenatal follow-up, appropriate delivery and timing of surgical intervention may significantly reduce morbidity and mortality.


Assuntos
Atresia Intestinal , Obstrução Intestinal , Volvo Intestinal , Adulto , Cesárea , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico por imagem , Volvo Intestinal/cirurgia , Intestinos , Masculino , Gravidez , Adulto Jovem
6.
J Pediatr Surg ; 56(7): 1251-1252, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33896615

RESUMO

Jan Hendrik Louw (1915-1992), considered the father of pediatric surgery in South Africa, gained prominence for his work on congenital intestinal atresia, a condition that had a mortality as high as 75 percent. His hypothesis, that jejunoileal atresia arose from mesenteric circulatory accidents in utero, was the dominant view until recent research uncovered the involvement of genetic and embryological mechanisms. In the mid-1950s he was one of a number of surgeons to resect the enlarged bulbous segment proximal to the site of the atresia, a crucial step in the surgical approach to intestinal atresia that brought mortality below 10 percent. A world leader in surgery as chair of surgery at the Groote Schur Hospital in Cape Town for more than a quarter century, his work in surgical research took root from his private tragedy early in his career of the death of his own infant son of intestinal atresia, a condition to which he would contribute so much.


Assuntos
Atresia Intestinal , Especialidades Cirúrgicas , Criança , Hospitais , Humanos , Lactente , Atresia Intestinal/cirurgia , Masculino , África do Sul , Circulação Esplâncnica
7.
Cir Pediatr ; 34(2): 74-78, 2021 Apr 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33826259

RESUMO

INTRODUCTION: Colonic atresia is a rare malformation accounting for 1.8-15% of all intestinal atresias. We present a 6-case series along with a bibliographic review. CLINICAL CASE: This 6-case series consists of three female cases and three male cases diagnosed 24-84 hours following birth. They were all located in the right hemicolon. The most relevant clinical signs included abdominal distension, absence of defecation, and bilious to fecal vomit. Repairs included primary or step-by-step anastomoses for bowel transit reconstruction. One patient diagnosed at > 72 hours of life died. CONCLUSION: In our experience with colonic atresia, when primary or step-by-step intestinal recanalization (diversion for future repair) is achieved, the expected prognosis is excellent, provided that colonic atresia has been diagnosed at 24-48 hours of life.


Assuntos
Atresia Intestinal , Colo/anormalidades , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/cirurgia , Masculino
11.
J Nepal Health Res Counc ; 18(4): 792-794, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33510531

RESUMO

Conversion of fetal circulation to adult-type occurs immediately after birth but neonates with problems in the development of pulmonary vasculature are prone to revert back to fetal circulation. This phenomenon is known as flip-flop circulation which may be induced perioperatively and as such anesthesiologist are central to its management. We report a case of term neonate planned for repair of duodenal atresia that despite having no respiratory symptom preoperatively developed severe hypoxemia under anesthesia that was even unresponsive to 100% oxygen. The intraoperative hemodynamics of the neonate was managed along with supportive care successfully. A postoperative echocardiogram confirmed the evidence of persistent pulmonary hypertension of the newborn. Keywords: Duodenal atresia; flip flop circulation; neonates; persistent pulmonary hypertension of newborn.


Assuntos
Anestesia , Hipertensão Pulmonar , Atresia Intestinal , Obstrução Duodenal , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Recém-Nascido , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/cirurgia , Nepal , Gravidez
12.
J Invest Surg ; 34(8): 842-847, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31913765

RESUMO

INTRODUCTION: Surgical management of jejuno-ileal atresia/stenosis (JIA) is shifting to a minimally invasive approach. Our purpose is to evaluate the safety and feasibility of laparoscopy-assisted surgery (LAS) in JIA by comparing outcomes with a control group of open surgery (OS). METHODS: A retrospective review of JIA cases was performed. Demographic, surgical, and outcomes data were extracted. LAS cases were compared with OS. Fisher's exact-test for qualitative and Mann-Whitney-test for quantitative values were used. p values <0.05 were considered significant. RESULTS: Forty-seven patients (24/23, F/M) were included. In 19 (40%), the LAS technique was successfully performed, while 3 (17%) required conversion to OS. No differences were observed between the LAS and OS (n = 28) groups concerning demographic data (sex, mean gestational age, mean weight, associated anomalies) and type of JIA. Operative time was shorter in LAS (112 ± 46 min) compared to OS (138 ± 40 min), p = 0.04. Time to start enteral feeding and time to full enteral was shorter in LAS compared to OS, p = 0.04. No difference was observed between the two groups concerning duration of parenteral nutrition, length of hospitalization and weight at discharge. Overall rate of postoperative complications was 14% (n = 7), with a slightly prevalence in OS (18%) compared to LAS (10%), p = 0.68. CONCLUSIONS: The LAS technique in the treatment of neonatal JIA is safe and feasible. LAS is associated with shorter operative and restoration of enteral feeding times. The post-operative outcomes in LAS are similar with OS, with a lower rate of postoperative complications.


Assuntos
Atresia Intestinal , Laparoscopia , Conversão para Cirurgia Aberta , Humanos , Recém-Nascido , Atresia Intestinal/epidemiologia , Atresia Intestinal/cirurgia , Laparoscopia/efeitos adversos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
15.
Medicine (Baltimore) ; 99(50): e23613, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327332

RESUMO

RATIONALE: Rectal atresia caused by necrotizing enterocolitis (NEC) is a serious and rare complication in children. Magnetic compression anastomosis (MCA) has been effectively applied in children with congenital oesophageal atresia and biliary atresia. Herein, we reported a case of successfully application of MCA in an infant with rectal atresia following NEC. PATIENT CONCERNS: A 30 weeks premature birth female fetal infant was transferred to our neonatal intensive care unit due to premature delivery, low birth weight, and neonatal respiratory distress. On postpartum day 11, the infant developed abdominal distension and mucosanguineous feces. This infant was then clinically diagnosed as NEC. She underwent anesthesia and intestinal fistula operation on postpartum day 11 because of NEC. DIAGNOSIS: After 3 months, radiographic examination revealed rectal atresia and stricture. INTERVENTIONS: This infant was successfully treated with MCA following a cecum-rectal anastomosis and ileocecal valve was reserved. OUTCOMES: On postoperative day 9, she passed the 2 magnets per rectum. In addition, there were no difficult defecation or fecal incontinence or other short-term complications. After the 7-month follow-up, the patient had an excellent clinical outcome. LESSONS: MCA is a feasible and effective method for treating rectal atresia in infants.


Assuntos
Enterocolite Necrosante/diagnóstico , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Atresia Intestinal/diagnóstico , Reto/anormalidades , Anastomose Cirúrgica , Diagnóstico Diferencial , Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/complicações , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/cirurgia , Imãs
16.
Can J Surg ; 63(6): E517-E526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33155974

RESUMO

BACKGROUND: Comparing adverse outcomes following alternative surgical interventions is a complex process for both patients and providers. Disability-adjusted life years (DALYs) are used globally as a quantitative indicator of burden of disease. However, DALYs have not been applied to the burden of postoperative complications. This study explores the feasibility and utility of DALYs in measuring the burden of postoperative complications, using 2 pediatric surgical procedures as a test model. METHODS: A literature review was undertaken of postoperative complications following pediatric inguinal hernia repair and intestinal atresia repair. Relevant studies were included, and incidence rates and durations of all key complications were identified. Using existing disability weights of equivalent health states to the complications, we estimated the burden in DALYs of each complication. These estimates were combined into a unitary procedure-specific complication burden score. RESULTS: The key complications contributing to the postoperative burden following inguinal hernia repair were recurrence (0.016 DALYs), hydrocele (0.010), metachronous hernia (0.014) and port-site hernia (0.012). In the case of intestinal atresia repair, death (6.278), reoperation (12.100), stenosis (5.025) and anastomotic stricture (5.327) accounted for most of the postoperative DALYs. The complication burden score was 0.06 DALYs for inguinal hernia and 36.86 for intestinal atresia repair. CONCLUSION: As a proof of concept, this study supports the feasibility of using DALYs to derive a complication burden score following surgical intervention, and to our knowledge it represents the first application of burden of disease metrics to postoperative adverse outcomes. Future studies should focus on deriving de novo disability weights for common postoperative complications and adverse outcomes.


Assuntos
Efeitos Psicossociais da Doença , Avaliação de Resultados em Cuidados de Saúde/métodos , Complicações Pós-Operatórias/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Criança , Estudos de Viabilidade , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Incidência , Atresia Intestinal/cirurgia , Assistência Centrada no Paciente , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Estudo de Prova de Conceito , Reoperação/estatística & dados numéricos
19.
Medicine (Baltimore) ; 99(31): e21439, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756156

RESUMO

RATIONALE: Duodenal atresia in association with situs inversus abdominus is extremely rare. Care should be taken when selecting appropriate surgical methods, and caution should be exercised during the surgery to avoid misdiagnosis and mistreatment. With prompt recognition of the condition, the surgical procedure should be performed in a timely manner to achieve positive results. PATIENT CONCERNS: A newborn affected by situs inversus abdominus associated with duodenal atresia, midgut malrotation, and volvulus. DIAGNOSIS: Congenital duodenal atresia with situs inversus abdominis. INTERVENTIONS: Diamond-shaped duodenoduodenostomy with appendectomy was performed, with the release of Ladd band and correction of the malrotation. OUTCOMES: The baby boy is thriving well with no abdominal complaints at 4 years of surgical follow-up. LESSONS: Although several theories are put forward to clarify this matter, the proper cause of duodenal atresia is not well defined. Clinical symptoms and examinations can assist diagnosis, the definitive cause should be ascertained by surgical approach. And the operating surgeon must be aware of the "mirror anatomy" to prevent unnecessary injuries. Additionally, long-term prognosis for duodenal atresia are very good, therefore, careful attention in postoperative management are important in such a case.


Assuntos
Obstrução Duodenal/congênito , Obstrução Duodenal/complicações , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Atresia Intestinal/complicações , Atresia Intestinal/cirurgia , Situs Inversus/complicações , Assistência ao Convalescente , Anastomose Cirúrgica/métodos , Apendicectomia/métodos , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico , Obstrução Duodenal/diagnóstico , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Masculino , Situs Inversus/diagnóstico , Resultado do Tratamento
20.
J Coll Physicians Surg Pak ; 30(7): 760-761, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32811611

RESUMO

Surgical field fire is a very rare intraoperative complication and has potentially serious consequences. Cases of surgical field fire have been reported in literature. Usually, surgical field fire involves airway, but it can also occur in surgical field. We, hereby report a case of surgical field fire while operating on a 4-week baby for jejunal atresia. In this case report, we review causes and preventive measures for surgical field fire. Key Words: Surgical field, Fire, Neonate, Prevention, Operation theatre.


Assuntos
Incêndios , Salas Cirúrgicas , Humanos , Recém-Nascido , Atresia Intestinal/cirurgia , Complicações Intraoperatórias
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