Management of multiple jejunoileal atresias with an intraluminal SILASTIC stent.

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.