A case of fetal midgut volvulus and jejunal atresia: nutritional support and maintenance of mucosal function and integrity.
Fetal midgut volvulus is a quite rare disease. Here, we report a case of a preterm newborn with fetal peritonitis, jejunal atresia with volvulus of post-atresic small bowel since about 30 cm from ileo-cecal valve (ICV) followed by a not-used microileus and microcolon. The surgical intervention consisted in the resection of volvulated necrotic small bowel followed by primary anastomosis. After surgery, total parenteral nutrition (TPN) has been started since 16(th) of post-operative days when enteral feeding (EN) was administered with a lactose-free formula containing hydrolyzed protein and medium-chain triglycerides (Pregestimil). Re-establishing intestinal continuity was preferred rather than stoma that would have required TPN. In fact, re-operation could have led to a shorter residual small bowel (RSB), since the anastomosis was at 15 cm from ICV. Our study provides evidence that not only the type of procedure (enteral versus parenteral) of nutritional support, but also the type of milk may modify the outcome. Early EN should be encouraged in newborn abdominal surgical patients because it is associated with reduced complications.
Baldassarre
Maria Elisabetta
ME
Department of Gynecology, UO of Neonatology and NICU, University of Bari, Bari, Italy. baldassarre@bioetaev.uniba.it
Laneve
Annamaria
A
Rizzo
Antonino
A
Dileo
Angela
A
Schettini
Federico
F
Filannino
Antonia
A
Laforgia
Nicola
N
D000714:Anastomosis, Surgical; D002364:Caseins / Q000008:administration & dosage; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004750:Enteral Nutrition; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D041943:Infant Formula / Q000008:administration & dosage; D007231:Infant, Newborn; D007234:Infant, Premature; D007409:Intestinal Atresia / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D007413:Intestinal Mucosa / Q000002:abnormalities / Q000601:surgery; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D007583:Jejunum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D018529:Nutritional Support / Q000009:adverse effects; D010289:Parenteral Nutrition, Total; D010538:Peritonitis / Q000628:therapy; D011492:Protein Hydrolysates / Q000008:administration & dosage; D011859:Radiography; D016896:Treatment Outcome
D002364:Caseins; D011492:Protein Hydrolysates; C097269:pregestimil