Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions.
Repeated or prolonged organic obstruction of the small intestine in the neonatal period can lead to severe refeeding problems, despite a transient ostomy. These problems are thought to result from a postobstructive enteropathy (POE) of the apparently normal small intestine segment above the obstruction. Ten infants with a POE, characterized by limited oral caloric and carbohydrate intakes and increased ostomy effluent, were compared with 8 controls with an enterostomy and a normal postoperative refeeding pattern. There was no statistical difference in the histomorphometric appearance of the mucosa or its digestive or absorptive capacity (brush-border hydrolases, glucose transport) between the two groups. The effluent and duodenal floras of the two groups were similar. However, all POE patients showed significant abnormal peristalsis characterized by barium and carmin transit times. This suggests that repeated or prolonged obstruction in the neonatal period could lead to a POE, caused by chronic motricity abnormalities of the small intestine above the obstruction. Although this POE is more frequent after small bowel atresia, it may also occur with other conditions causing prenatal and postnatal intestinal obstruction.
Cezard
J P
JP
Service de Gastroentérologie Pédiatrique, Hôpital Robert Debré, Paris, France.
Aigrain
Y
Y
Sonsino
E
E
Lambert
N
N
Macry
J
J
Grasset
E
E
Weisgerber
G
G
Navarro
J
J
D004766:Enterostomy / Q000009:adverse effects*; D005769:Gastrointestinal Motility; D006801:Humans; D007231:Infant, Newborn; D007408:Intestinal Absorption; D007410:Intestinal Diseases / Q000209:etiology* / Q000503:physiopathology; D007415:Intestinal Obstruction / Q000601:surgery*; D007421:Intestine, Small / Q000382:microbiology / Q000503:physiopathology*; D010288:Parenteral Nutrition / Q000009:adverse effects; D011183:Postoperative Complications; D012008:Recurrence