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A Preliminary Report in Efficacy of The Lateral T-Stoma: Solution for Functional Obstruction and Short Bowel Sydrome in High Jejunoileal Atresia [Behcet Uz Cocuk Hast Derg]
Behcet Uz Cocuk Hast Derg. Ahead of Print: BUCHD-33866 | DOI: 10.5222/buchd.2021.33866  

A Preliminary Report in Efficacy of The Lateral T-Stoma: Solution for Functional Obstruction and Short Bowel Sydrome in High Jejunoileal Atresia

Ayşenur Celayir, Tugce Merve Orbay, Naime İpek Öztürk, Olga Devrim Ayvaz, Şefik Çaman
Health Sciences University, Istanbul Zeynep Kamil Women's and Children's Diseases Health Application and Research Center, Pediatric Surgery Clinic, İstanbul, Türkiye

Objective: This study is a preliminary report in the efficacy of lateral T-stoma (LTS), which we developed as a solution for anastomosis dysfunction and/or short bowel syndrome in the jejunoileal atresia (JIA).
Method: The primary pathologies and results of all cases who underwent lateral t-stoma between July 2017-2020 were evaluated retrospectively.
Results: Case 1 with meconium pseudocysts secondary to intrauterine volvulus had Type-3A JIA at 50 cm from the Treitz, and end-oblique anastomosis was performed. The LTS was created proximal to the first anastomosis. on Day 15 due to abdominal distension with 5/1 diameter ratio. The patient was discharged 13 days later. The LTS was closed in the 10th month. In Case 2 with Type-2 JIA at 60 cm from the Treitz, primary LTS was created proximal to the anastomosis with 5/1 diameter ratio. Patient was discharged 15 days later. The LTS was closed in the 10th month. End-to-side anastomosis was performed in Case 3 with Type-2 JIA located 70 cm from Treitz. Anastomotic leakage occurred on Day 36, and the LTS was created with 6/1 diameter ratio. The LTS was closed in the 5th month. Prenatally diagnosed Case 4 was postnatally intubated due to pulmonary hypertension, and surfactant was applied. Intrauterine volvulus, meconium pseudocyst and intestinal perforation were detected at 50 cm from the Treitz, and jejunoileal anastomosis together with primary LTS was performed with 5/1 diameter ratio. Nasogastric feeding started on the 10th day, but patient was lost on Day 44 without extubation. Primary repair and end-stoma were performed in Case 5 with gastroschisis/intestinal atresia with perforation. Due to high-flow stomal discharge/weight loss, the ileo-colic anastomosis and LTS were performed proximal to anastomosis with 3/1 diameter ratio at 60 cm from Treitz on Day 68. Patient was discharged on Day 90. In Case 6 with prenatal diagnosis as meconium cyst with Type-2 JIA (at 65 cm from Treitz), primary LTS was created proximal to the anastomosis with 4/1 diameter ratio. The LTS was closed in the 14th month due to high-flow stomal discharge.
Conclusion: Creation of lateral T-stoma proximal to the anastomosis in JIAs with large differences in diameters may shorten hospitalization time and relieve functional obstruction/short bowel syndrome.

Keywords: Jejunoileal atresia, Meconium Ileus, Neonatal Obstructions, Enterostomy, Bishop-Koop Prosedure, Santulli.


Yüksek Jejunoileal Atrezide Fonksiyonel Tıkanma ve Kısa Barsak Sendromu için Çözüm: Lateral T-Stoma'nın Etkinliğine İişkin Bir Ön Rapor

Ayşenur Celayir, Tugce Merve Orbay, Naime İpek Öztürk, Olga Devrim Ayvaz, Şefik Çaman
Sağlık Bilimleri Üniversitesi, İstanbul Zeynep Kamil Kadın ve Çocuk Hastalıkları SUAM, Çocuk Cerrahisi Kliniği, İstanbul, Türkiye

Amaç: Bu çalışma, jejunoileal atrezide (JIA) anastomoz disfonksiyonu ve/veya Kısa Barsak Sendromu (SBS) için bir çözüm olarak geliştirdiğimiz lateral T-stomanın (LTS) etkinliğine ilişkin bir ön rapordur.
Yöntem: Temmuz 2017-2020 tarihleri arasında lateral T-stoma yapılan olguların birincil patolojileri ve sonuçları geriye dönük olarak değerlendirildi.
Bulgular: İntrauterin volvulusa sekonder mekonyum psödokistli ilk olguda Treitz’den 50 cm uzaklıkta Tip-3a JIA mevcuttu, uç oblik anastomoz yapıldı. Abdominal distansiyon nedeniyle 15. gün 5/1 çap farkı nedeniyle anastomoz proksimalinden LTS oluşturuldu. Hasta 13. gün taburcu edildi, 10. ayda stoması kapatıldı.
Treitz’den 60 cm uzaklıkta Tip-2 JIA’li ikinci olguda, 5/1 çap farkı nedeniyle anastomoz ve proksimalinde primer LTS oluşturuldu, 15. gün taburcu edildi, 10. ayda stoması kapatıdı. Treitz’e 70 cm uzaklıkta bulunan Tip 2 JİA’lı 3. olguda uç-yan anastomoz yapıldı. 36. gün anastomoz kaçağı nedeniyle yeniden opere edildiğinde 6/1 çap farkıyla LTS oluşturuldu, 5.ayda stoması kapatıldı. Prenatal tanılı 4.olgu pulmoner hipertansiyon nedeniyle doğum sonrası entübe edildi, sürfaktan uygulandı. İntrauterin volvulus, mekonyum psödokisti ve Treitz’den 50 cm’de barsak perforasyonu ve 5/1 çap farkı nedeniyle primer LTS yapıldı. Nazogastrik beslenme 10. gün başladı, ancak hasta 44. gün ekstübe edilemeden kaybedildi. Gastroşizis, intestinal atrezi ve barsak perforasyonu olan 5.olguda primer onarım ve end-stoma yapıldı. Yüksek debili stomadan kilo kaybı nedeniyle, 68. gün Treitz’den 60 cm’de 3/1 çap farkıyla ileo-kolik anastomoz proksimalinden LTS oluşturuldu, 90.gün taburcu edildi. Prenatal intrauterin volvulus/mekonyum kisti tanılı 6. olguda Treitz’den 65 cm’de Tip-2 JIA’ya 4/1 çap farkı nedeniyle anastomoza proksimalde primer LTS oluşturuldu. Yüksek debili stoma gelenleri nedeniyle 3,5. ayda stoması kapatıldı.
Sonuç: Büyük çap farklılıkları olan JİA’lerde anastomozun proksimalinde lateral T-stoma oluşturulması hastanede kalış süresini kısaltabilir, fonksiyonel obstrüksiyon ve kısa bağırsak sendromu bulgularını hafifletebilir.

Anahtar Kelimeler: Jenunoileal Atrezi, Mekonyum İleus, Yenidoğan Tıkanıklıkları, Enterostomi, Bishop-Koop Prosedürü, Santulli.




Corresponding Author: Olga Devrim Ayvaz, Türkiye


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