Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3353-3357
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3353
Alternative technique to save ischemic bowel segment in management of neonatal short bowel syndrome: A case report
Lei Geng, Lei Zhou, Guo-Jian Ding, Xiao-Liang Xu, Yu-Mei Wu, Ji-Jun Liu, Ting-Liang Fu
Lei Geng, Guo-Jian Ding, Xiao-Liang Xu, Ting-Liang Fu, Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Lei Zhou, Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Yu-Mei Wu, Department of Neonatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Ji-Jun Liu, Department of Anorectal Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Author contributions: Zhou L and Geng L contributed equally to this work; Fu TL designed research; Fu TL, Geng L, Ding GJ, Xu XL, Wu YM and Liu JJ performed research; Zhou L and Ding GJ wrote the paper; Fu TL is the guarantor.
Informed consent statement: Written informed consent was obtained from the guardians of the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ting-Liang Fu, MD, PhD, Chief Doctor, Director, Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China. drfutl@sina.com
Telephone: +86-543-3258672
Received: July 19, 2019
Peer-review started: July 22, 2019
First decision: August 2, 2019
Revised: September 3, 2019
Accepted: September 9, 2019
Article in press: September 9, 2019
Published online: October 26, 2019
Processing time: 98 Days and 16.9 Hours
Abstract
BACKGROUND

Congenital short bowel syndrome (SBS) associated with malrotation, gut volvulus and jejuno-ileal atresia is a very rare condition. It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates.

CASE SUMMARY

We report a newborn baby with gut malrotation associated with jejuno-ileal atresia, congenital SBS and jejunal volvulus. Hematemesis and abdominal distention were noted. At laparotomy, malrotation associated with jejuno-ileal atresia, congenital SBS and jenunal volvulus was confirmed. The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm, including 18 cm necrotic segment below the Treitz’s ligament and 20 cm severe ischemic segment. The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter. Ladd’s procedure, necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed. The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure. Three months later, to restore the continuity of the isolated gut segment, end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed. The entire functional small bowel length increased to 80 cm. Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively. Twelve months later, her body weight was 9.5 kg.

CONCLUSION

Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.

Keywords: Ischemic bowel segment; Short bowel syndrome; Bowel isolation technique; Staged salvaging procedure; Case report

Core tip: Congenital short bowel syndrome (SBS) associated with malrotation, gut volvulus and jejuno-ileal atresia is a very rare condition. A newborn baby with gut malrotation associated with jejuno-ileal atresia, congenital short bowel syndrome, and jejunal volvulus. Ladd’s procedure, necrotic segment resection, end-to-back duodeno-ileal anastomosis were performed. Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infant with SBS are safe and feasible.