Gastrointestinal bleeding as a complication of serial transverse enteroplasty.
OBJECTIVE
Serial transverse enteroplasty (STEP) lengthens and tapers bowel in patients with intestinal failure. Evaluation and treatment of serious late gastrointestinal bleeding (GIB) in three STEP patients are described.


METHODS
Patients participating in an interdisciplinary intestinal rehabilitation program were reviewed to identify those who underwent STEP and had GIB requiring transfusion.


RESULTS
Of 296 patients, 23 underwent STEP, and 3 (13%) had subsequent GIB requiring transfusion. Diagnoses were vanishing gastroschisis/atresia, malrotation/atresia, and gastroschisis.. STEP was performed at ages 3-5 months, using 5-15 stapler-firings with an increase in mean bowel length from 39 to 62 cm. GIB was diagnosed 5-30 months post-op and resulted in 1-7 transfusions per patient. Endoscopy demonstrated staple-line ulceration in two patients and eosinophilic enterocolitis in the third. All were treated with enteral antibiotics, sulfasalazine, and luminal steroids. Those with ulcers responded to bowel rest, and the patient with eosinophilic enterocolitis stabilized with luminal steroids. In all three, hemoglobin levels improved despite persistent occult bleeding.


CONCLUSIONS
Significant GIB is a potential late complication of STEP. Endoscopy identified the underlying source of GIB in all three patients. A combination of enteral antibiotics, anti-inflammatory medications, and bowel rest was effective in treating post-STEP GIB, without the need for additional bowel resection.
Department of Surgery, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School.
Jeremy G
JG
Fisher
Department of Surgery, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School.
Danielle A
DA
Stamm
Department of Surgery, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School.
Biren P
BP
Modi
Division of Gastroenterology and Nutrition, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School.
Christopher
C
Duggan
Department of Surgery, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School. Electronic address: tom.jaksic@childrens.harvard.edu.
Tom
T
Jaksic
D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D017707:Erythrocyte Transfusion; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D020139:Gastroschisis / Q000601:surgery; D006801:Humans; D007223:Infant; D007409:Intestinal Atresia / Q000601:surgery; D045822:Intestinal Volvulus / Q000601:surgery; D007422:Intestines / Q000601:surgery*; D007583:Jejunum / Q000002:abnormalities / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery / Q000628:therapy; D013997:Time Factors
Autologous intestinal reconstruction surgery (AIRS); Gastrointestinal hemorrhage; Intestinal failure; Serial transverse enteroplasty (STEP); Short bowel syndrome