Intestinal atresia with gastroschisis: A selective approach to management

Fleet, M.; Hunt, M.N de la

doi:10.1053/jpsu.2000.9324

Cited by 50 publications

(45 citation statements)

References 6 publications

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“…In the case of excess abdominal tension due to disproportional abdominal cavity or compromised ventilation, delayed closure with placement of a prosthetic silo was performed (n = 11, of which 3 with compromised bowel, ns). The treatment of choice for gastroschisis has been extensively debated and literature presents a great heterogeneity among the available evidence [17][18][19][20][21]. Closure-related complications after primary closure could be minimized with the use of more objective measurements for excessive intra-abdominal pressure peri-operatively [22,23].…”

Section: Discussionmentioning

confidence: 99%

Factors determining outcome in gastroschisis: clinical experience over 18 years

Jager

Heij

2007

Pediatr Surg Int

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Although the survival in gastroschisis has improved to more than 85%, serious morbidity with consequent long hospital stay is still very common. Alternative strategies such as planned early delivery and amniotic fluid exchange are being explored. In order to evaluate these approaches, adequate risk stratification of patients with gastroschisis is required. The aim of this study was to identify the risk factors associated with increased morbidity and mortality. A retrospective analysis of all patients with gastroschisis treated at our institution between 1988 and 2005 was conducted. Patients' data were collected from the files and compared for statistical significance with three outcome measures: (1) complicated post-operative course; (2) time to full enteral feeding (TFE); (3) length of hospital stay (LOS). SPSS was used for statistical analysis. Fifty-nine newborns with gastroschisis were admitted during the study period. Antenatal diagnosis was made in 40 cases (68%). Associated malformations (other than intestinal anomalies) were present in eight patients. One patient with trisomy 13 was excluded from the analysis. Ten patients (17%) had compromised bowel (atresia, severe ischaemia or a combination). Primary repair was successful in 47 (81%) and in 11 patients a silo was applied. Overall survival was 54/58 children (93%), four patients died. Complications associated with closure occurred in eight patients. Postoperative course was uncomplicated in 45 patients and complicated in 13. The RR for patients with compromised bowel to have a complicated post-operative course is 9 (95% CI 2-39) and the RR to die is 20 (95% CI 2-222) for these patients. Risk stratification of patients with gastroschisis appears possible based on the presence of compromised bowel before closure.

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Section: Discussionmentioning

confidence: 99%

Factors determining outcome in gastroschisis: clinical experience over 18 years

Jager

Heij

2007

Pediatr Surg Int

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“…49,51,52 Even if a BA is identified at birth, the surgeon is often facing the dilemma whether performing an early or a delayed repair of the interrupted intestine. [51][52][53] The main surgical concerns in this situation are about the degree of bowel inflammation, edema, necrosis, and the increased abdominal pressure after the abdominal wall closure that can all increase the risk of surgical complications. For this reason, being able to predict the presence of BA in newborns with gastroschisis could significantly help the surgeon to plan the repair, either with an anastomosis or with a diverting ileostomy at the time of the abdominal wall closure.…”

Section: Implication For Clinical Practicementioning

confidence: 99%

Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis

et al. 2015

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BACKGROUND AND OBJECTIVE: Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay).

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“…This retrograde perfusing artery of the apple-peel predominately compensates for the interrupted superior mesenteric artery [8]. Infants with complex gastroschisis carry an increased risk for small bowel atresia or CA [9] [10]. To the best of our knowledge, this is the first detailed report on the association of CA with an apple-peel phenotype affecting the small gut in combination with the ileocolic region.…”

Section: Introductionmentioning

confidence: 83%

“Inverse Type” Apple-Peel Syndrome Is Associated with Type III Colonic Atresia in a Neonate with Gastroschisis—A “New” Subtype of Colonic Atresia

Tröbs¹,

Bahr²,

Schulze³

et al. 2015

OJPed

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The colon is an unusual site of intestinal atresia. Colonic atresia is subdivided into three phenotypes. Type III is the most common phenotype, where the proximal and distal blind sacs are not connected. Here, we report on the presence of colonic atresia with an "inverse apple-peel" appearance in a neonate with gastroschisis. The lack of mesenteric fixation of the entire small intestine, including the proximal colon, and the twisting around the vascular axis of the superior mesenteric artery led to intrauterine volvulus and hemorrhagic infarction of the ileocolic bowel at 34 weeks of gestation. According to the current nomenclature for small bowel atresia, we introduce type IIIB into the current colonic atresia classification. The occurrence of type IIIB has been mentioned in the literature, but no single cases have been reported until now. Patients with this type of atresia are predisposed to the loss of the ileocecal region.

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Intestinal atresia with gastroschisis: A selective approach to management

Cited by 50 publications

References 6 publications

Factors determining outcome in gastroschisis: clinical experience over 18 years

Factors determining outcome in gastroschisis: clinical experience over 18 years

Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis

“Inverse Type” Apple-Peel Syndrome Is Associated with Type III Colonic Atresia in a Neonate with Gastroschisis—A “New” Subtype of Colonic Atresia

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