Baldassarre Maria Elisabetta, Laneve Annamaria, Rizzo Antonino, Dileo Angela, Schettini Federico, Filannino Antonia, Laforgia Nicola
Department of Gynecology, UO of Neonatology and NICU, University of Bari, Bari, Italy.
Immunopharmacol Immunotoxicol. 2008;30(3):601-8. doi: 10.1080/08923970802135567.
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.
胎儿中肠扭转是一种相当罕见的疾病。在此，我们报告一例早产新生儿病例，该患儿患有胎儿腹膜炎、空肠闭锁，自距回盲瓣（ICV）约30厘米处起闭锁后小肠发生扭转，随后出现未使用的微肠梗阻和微结肠。手术干预包括切除扭转坏死的小肠，然后进行一期吻合。术后，自术后第16天开始全肠外营养（TPN），此时开始肠内喂养（EN），采用含水解蛋白和中链甘油三酯的无乳糖配方奶粉（普瑞米尔）。重建肠道连续性优于造口术，因为造口术需要TPN。事实上，再次手术可能会导致残余小肠（RSB）更短，因为吻合口距ICV为15厘米。我们的研究表明，不仅营养支持的方式（肠内与肠外），而且奶粉的类型都可能改变结果。对于新生儿腹部手术患者，应鼓励早期进行EN，因为这与并发症减少相关。
