Closed gastroschisis: total parenteral nutrition-free survival with aggressive attempts at bowel preservation and intestinal adaptation.

Abstract

BACKGROUND:

In infants with gastroschisis antenatal closure of the umbilical defect results in a proximal atresia with ischemia and/or volvulus of the extracorporeal midgut. It has been described as "closed gastroschisis" or "vanishing midgut."

METHODS:

A 10-year review of 219 gastroschisis patients identified 10 infants with this rare complication.

RESULTS:

In these 10 infants, the extracorporeal midgut was invariably matted and fibrosed. In 3 cases, the midgut had completely "vanished." In the remaining 7 cases, the remnant midgut was surgically reduced into the abdominal cavity with care not to compromise the diminutive vascular pedicle. Abdominal exploration was performed several weeks later to reestablish bowel continuity; 4 required an ostomy and 2 underwent a serial transverse enteroplasty. Mean residual length of salvaged small bowel was 79 cm with retention of the distal half of the colon. Eight infants survived the initial hospitalization, with a mean length of stay of 121 days and mean hospital charge of $287,094. Six of the 7 long-term survivors have been completely weaned off total parenteral nutrition.

CONCLUSION:

A nihilistic attitude toward infants with closed gastroschisis may not be uniformly supported because in the majority of these infants' long-term independence from total parenteral nutrition was achieved.

• Authors: Sarah A Vogler, Stephen J Fenton, Eric R Scaife, Linda S Book, Daniel Jackson, Peter F Nichol, Rebecka L Meyers
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 43 Issue 6 Pg. 1006-10 (Jun 2008) ISSN: 1531-5037 [Electronic] United States
• PMID: 18558174 (Publication Type: Journal Article)

Topics

• Adaptation, Physiological
• Cause of Death
• Cohort Studies
• Female
• Fetal Diseases (diagnostic imaging, surgery)
• Follow-Up Studies
• Gastroschisis (diagnosis, mortality, surgery, therapy)
• Humans
• Infant, Newborn
• Intestinal Atresia (diagnosis, mortality, surgery)
• Intestines (physiology)
• Male
• Parenteral Nutrition, Total (methods)
• Prenatal Diagnosis
• Retrospective Studies
• Risk Assessment
• Salvage Therapy (methods)
• Severity of Illness Index
• Survival Analysis
• Treatment Outcome
• Ultrasonography