A case report of a newborn who underwent ultra-high enterostomy and intestinal fluid return after necrosis of intestinal volvulus.

BACKGROUND

Neonatal intestinal malrotation complicated by midgut volvulus is a serious and common life-threatening complication. When the midgut volvulus is prolonged or severe, it can lead to secondary necrosis of the entire midgut, with high mortality rates. Therefore, improving understanding the clinical characteristics of this condition is necessary to facilitate early diagnosis and treatment. Herein, we report a case of congenital intestinal malrotation and necrosis of the midgut volvulus in a newborn.

CASE DESCRIPTION

The patient was admitted to the hospital with vomiting, abdominal distension, and bloody stools. An emergency laparotomy revealed a large-area necrosis of the small intestine and torsion of the mesenteric root. External intestinal placement was performed initially, followed by a secondary laparotomy 72 hours later, which showed complete necrosis of the jejunum but recovery of the ileum. Duodenal and ileal ultra-high position fistulas were created, which were managed by intestinal fluid return and milk micropump feeding. Following that, fistula formation was performed 84 days after the second operation, and full enteral feeding was quickly achieved. The growth and development of the child were good at later follow-ups.

CONCLUSIONS

The condition of the intestine in severe cases of neonatal intestinal malrotation combined with necrosis of midgut volvulus is unpredictable. The comprehensive management of operation timing, operation method, and close cooperation between neonatal physicians, surgeons, and nursing teams can greatly improve the success rate of treatment.