Small-bowel continuity: a crucial factor in determining survival in gastroschisis.
A retrospective analysis of a series of 63 cases of gastroschisis managed over an 11-year period distinguished a single statistically significant prognostic factor. There were 6 (9.5%) deaths, of which 4 occurred in the 8 infants with small-bowel atresia/stenosis (P < 0.005, Fisher's exact test). One died at 48 h and the remaining 3 of liver disease related to total parenteral nutrition. Of the 4 survivors, 1 developed a late biliary stricture necessitating hepaticoenterostomy but is alive and well aged 4 years. The remaining 3, following initially prolonged hospitalisations and multiple operations, are alive and well after 2, 4 and 7 years. In 3 patients the atresia was not detected at the primary operation. The small number of cases of gastroschisis-associated small-bowel atresia seen in any one unit may conceal the importance of the problem, and limits experience in the approach to management.
Cusick
E
E
Department of Paediatric Surgery, Leeds General Infirmary, UK.
Spicer
R D
RD
Beck
J M
JM
D000009:Abdominal Muscles / Q000002:abnormalities*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D017093:Liver Failure / Q000209:etiology; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome