Closed gastroschisis: total parenteral nutrition-free survival with aggressive attempts at bowel preservation and intestinal adaptation.
BACKGROUND
In infants with gastroschisis antenatal closure of the umbilical defect results in a proximal atresia with ischemia and/or volvulus of the extracorporeal midgut. It has been described as "closed gastroschisis" or "vanishing midgut."


METHODS
A 10-year review of 219 gastroschisis patients identified 10 infants with this rare complication.


RESULTS
In these 10 infants, the extracorporeal midgut was invariably matted and fibrosed. In 3 cases, the midgut had completely "vanished." In the remaining 7 cases, the remnant midgut was surgically reduced into the abdominal cavity with care not to compromise the diminutive vascular pedicle. Abdominal exploration was performed several weeks later to reestablish bowel continuity; 4 required an ostomy and 2 underwent a serial transverse enteroplasty. Mean residual length of salvaged small bowel was 79 cm with retention of the distal half of the colon. Eight infants survived the initial hospitalization, with a mean length of stay of 121 days and mean hospital charge of $287,094. Six of the 7 long-term survivors have been completely weaned off total parenteral nutrition.


CONCLUSIONS
A nihilistic attitude toward infants with closed gastroschisis may not be uniformly supported because in the majority of these infants' long-term independence from total parenteral nutrition was achieved.
Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA.
Sarah A
SA
Vogler
Stephen J
SJ
Fenton
Eric R
ER
Scaife
Linda S
LS
Book
Daniel
D
Jackson
Peter F
PF
Nichol
Rebecka L
RL
Meyers
D000222:Adaptation, Physiological; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D007422:Intestines / Q000502:physiology; D008297:Male; D010289:Parenteral Nutrition, Total / Q000379:methods*; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography