Abstract

How can we improve perinatal care in isolated multiple intestinal atresia? A retrospective study with a 30-year literature review

Arch Pediatr. 2021 Mar 2;S0929-693X(21)00003-8. doi: 10.1016/j.arcped.2020.12.010.Online ahead of print.

N Vinit 1, D Mitanchez 2, J Lemale 3, C Garel 4, J-M Jouannic 5, E Hervieux 1, G Audry 6, S Irtan 7

 
     

Author information

  • 1Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France.
  • 2Department of Neonatology, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France.
  • 3Department of Pediatric Nutrition and Gastroenterology, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France.
  • 4Department of Pediatric Radiology, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France.
  • 5Department of Obstetrics and Fetal Medicine, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France.
  • 6Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France.
  • 7Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau, APHP, 26, avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne Université, Paris, France. Electronic address: sabine.irtan@aphp.fr.

Abstract

Introduction: Multiple intestinal atresia (MIA) is a rare cause of neonatal intestinal obstruction. To provide an overview of the current prenatal, surgical, and nutritional management of MIA, we report our experience and a literature review of papers published after 1990.

Methods: All cases of isolated MIA (non-hereditary, not associated with apple-peel syndrome or gastroschisis) treated at our institution between 2005 and 2016 were reviewed and compared with cases found in the literature.

Results: Seven patients were prenatally suspected of having intestinal obstruction and were postnatally diagnosed with MIA, with a mean 1.7 (1-2) resections-anastomoses (RA) and 6 (1-10) strictureplasties performed, resulting in a mean resected bowel length of 15.1cm (15-25 cm). Median time to full oral feed was 46 days (14-626 days). All patients were alive and none had orality disorder after a mean follow-up of 3.1 years (0.2-8.1 years). Three surgical strategies were found in the literature review: multiple RA (68%, 34/50) including Santulli's technique in four of 34 (12%) and anastomoses over a transanastomotic tube (32%, 16/50), with a 98% survival rate, and short-bowel syndrome for only two patients.

Conclusion: Bowel-sparing surgery and appropriate medical management are key to ensuring a favorable nutritional and gastrointestinal outcome and a good prognosis. Prenatal assessment and standardization of the surgical course of treatment remain challenging.

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