Chaet M S, Warner B W, Sheldon C A
Department of Surgery, University of Cincinnati College of Medicine, Children's Hospital Medical Center, OH 45229-3039.
J Pediatr Surg. 1994 Dec;29(12):1604-6. doi: 10.1016/0022-3468(94)90234-8.
Multiple small bowel atresias present a unique challenge because maximum intestinal conservation is mandatory for survival. We recently treated a patient who had multiple atresias using a 7F SILASTIC catheter as an intraluminal stent. The catheter facilitated the completion of multiple primary anastomoses and served as a conduit for radiological evaluation and enteral feeding. The patient was a 1,860-g boy with 23 atresias of the jejunum and ileum. All stenotic segments were resected, and seven primary anastomoses were completed over the catheter. The distal 34 cm of bowel were exteriorized as a mucus fistula, with the catheter extending through to the level of the ileocecal valve. The proximal jejunal limb also was exteriorized. Eleven days later, contrast was instilled through the catheter and showed no leak or stricture. The catheter was then used for enteral nutrition and administration of the proximal jejunal effluent. Bowel continuity was reestablished after a tapering enteroplasty of the proximal jejunal limb. Parenteral nutrition was ultimately discontinued. Thirty-one months later, the patient no longer requires supplemental nutritional support. This case demonstrates the safety of multiple primary anastomoses over an exteriorized intraluminal stent. The catheter was useful in the radiological evaluation of the distal limb before it was used as an access route for enteral nutrition.
多处小肠闭锁带来了独特的挑战，因为最大限度地保留肠道对生存至关重要。我们最近治疗了一名患有多处闭锁的患者，使用一根7F硅橡胶导管作为腔内支架。该导管有助于完成多处一期吻合，并作为放射学评估和肠内营养的通道。患者是一名体重1860克的男婴，空肠和回肠有23处闭锁。所有狭窄段均被切除，在导管上完成了7处一期吻合。将远端34厘米的肠管外置形成黏液瘘，导管延伸至回盲瓣水平。近端空肠袢也被外置。11天后，通过导管注入造影剂，未显示渗漏或狭窄。然后将导管用于肠内营养和近端空肠流出物的给药。在对近端空肠袢进行缩窄肠成形术后重建了肠道连续性。最终停止了肠外营养。31个月后，患者不再需要补充营养支持。该病例证明了在体外腔内支架上进行多处一期吻合的安全性。在导管用作肠内营养的通路之前，它对远端肠袢的放射学评估很有用。
