Neonatal Serial Transverse Enteroplasty (STEP): Case Report

Abstract Case Report Gastroschisis is the most frequent congenital abdominal wall defect. When associated with intestinal atresia (complex gastroschisis), short bowel syndrome may occur. Complicated gastroschisis is the most frequent cause of short bowel syndrome in our series. The serial transverse...

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Bibliographic Details
Published in:	Transplantation proceedings Vol. 48; no. 2; pp. 528 - 531
Main Authors:	Lobos, P.A, Calello, S.E.M, Busoni, V.B, Urquizo Lino, M.M, Prodan, S.G, Sanchez Claria, R
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2016
Subjects:	Digestive System Surgical Procedures - methods Female Humans Infant, Newborn Intestinal Atresia - surgery Jejunum - surgery Reconstructive Surgical Procedures - methods Short Bowel Syndrome - surgery Surgery
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Summary:	Abstract Case Report Gastroschisis is the most frequent congenital abdominal wall defect. When associated with intestinal atresia (complex gastroschisis), short bowel syndrome may occur. Complicated gastroschisis is the most frequent cause of short bowel syndrome in our series. The serial transverse enteroplasty procedure has been used to lengthen the bowel and achieve intestinal rehabilitation in patients with dilated gut. The use of this technique in the newborn period, for tailoring the bowel while preserving absorptive mucosa, has been recently described. We present a video showing the surgical treatment of an intestinal obstruction produced by a complex intestinal atresia in a newborn baby in whom a primary closure of a gastroschisis had been done at birth. During laparotomy at the 21st day of life, a type IVa intestinal atresia was found, associated with a colonic stenosis. Proximal dilated jejunum was tailored with a serial transverse enteroplasty procedure, as shown in the video. End-to-end jejunal-ileal anastomosis was performed. Postoperative entero-cutaneous fistula occurred and was treated with vacuum-assisted therapy. Enteral feedings were initiated at 15 days after surgery. Parenteral nutrition was withdrawn at 30 days. After 16 months follow-up, actual weight was 8.7 kg (percentile 10% to 25%). The patient remained on full enteral feedings. Conclusions In cases of intestinal atresia, short bowel syndrome, and proximal dilated bowel, we propose an aggressive surgical approach to preserve bowel mucosal surface while tailoring the jejunal loop to improve motility. The serial transverse enteroplasty procedure is an acceptable alternative to tailoring methods that resect a segment of the bowel wall.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0041-1345 1873-2623
DOI:	10.1016/j.transproceed.2015.12.062