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

Archive ouverte

Vinit, N. | Mitanchez, D. | Lemale, J. | Garel, C. | Jouannic, J.-M. | Hervieux, E. | Audry, G. | Irtan, S.

Edité par CCSD ; Elsevier -

International audience. Introduction: Multiple intestinal atresia (MIA) is a rare cause of neonatal intestinal obstruction. In order to give an overview of its current prenatal, surgical and nutritional management, 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 to cases found in the literature. Results: Seven patients were prenatally suspected of intestinal obstruction and postnatally diagnosed with MIA, with a mean 1.7 [1-2] resections-anastomoses (RA) and 6 [1-10] stricturoplasties performed, resulting in a mean resected bowel length of 15.1 cm [15-25]. Median time to full oral feed was 46 days [14-626]. All patients were alive and none had orality disorder after a mean follow-up of 3.1 years [0.2-8.1]. Three surgical strategies were found in the review: multiple RA (68%, 34/50) including Santulli's technique in 4/34 (12%) and anastomoses over a transanastomotic tube (32%, 16/50), with a 98% survival rate and short-bowel syndrome for only two patients. Conclusions: Bowel-sparing surgery and appropriate medical management are key to ensure a favorable nutritional, gastrointestinal and vital prognosis. Prenatal assessment and standardizing the surgical course of treatment remain challenging.

• Description
• Sujet/Public
• Outil
• Outil d'anticipation
• Mémoire et thèse
• Gestion