MANAGEMENT OF MULTIPLE JEJUNOILEAL ATRESIAS WITH AN INTRALUMINAL SILASTIC(R) STENT

Multiple small bowel atresias present a unique challenge because maxim um intestinal conservation is mandatory for survival. We recently trea ted a patient who had multiple atresias using a 7F SILASTIC Registered Trademark catheter as an intraluminal stent. The catheter facilitated the completion of multiple primary anastomoses and served as a condui t for radiological evaluation and enteral feeding. The patient was a 1 ,860-g boy with 23 atresias of the jejunum and ileum. All stenotic seg ments 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 ileoc ecal valve. The proximal jejunal limb also was exteriorized. Eleven da ys later, contrast was instilled through the catheter and showed no le ak or stricture. The catheter was then used for enteral nutrition and administration of the proximal jejunal effluent. Rowel continuity was reestablished after a tapering enteroplasty of the proximal jejunal li mb. Parenteral nutrition was ultimately discontinued. Thirty-one month s later, the patient no longer requires supplemental nutritional suppo rt. This case demonstrates the safety of multiple primary anastomoses over an exteriorized intraluminal stent. The catheter was useful in th e radiological evaluation of the distal limb before it was used as an access route for enteral nutrition.