A NEW METHOD OF INTESTINAL SALVAGE FOR SEVERE SMALL-BOWEL ISCHEMIA

The morbidity and mortality in short bowel syndrome are directly relat ed to the length of the remaining small bowel and to the duration of t otal parenteral nutrition. We describe the successful salvage of an in fant with extensive small bowel infarction for whom a new technique wa s used to preserve all viable mucosal surfaces. The infant, with gastr oschisis, was found to have a tight volvulus of the extruded bowel and extensive small bowel ischemia at the time of delivery. Forty-eight h ours after reduction of the volvulus and abdominal decompression, a se cond-look laparotomy was performed. Although only the terminal 13 cm o f ileum was completely viable, 25% of the circumference of a further 2 3 cm of proximal jejunum/ileum was considered salvageable. After debri dement of the dead tissue, the remain ing gutter of jejunum was divide d at its midpoint, and the two halves were anastomosed longitudinally to provide a ''neojejunum'' of 12 cm in length, which was anastomosed between the duodenum and terminal ileum. Full enteral feeding was tole rated from day 47. Although the neojejunum was excised on day 149, aft er becoming dilated and atonic, by that time the remaining small bowel had elongated to 30 cm. Because of the early institution of full ente ral feeding, there were no long-term complications related to total pa renteral nutrition. Copyright (C) 1994 by W.B. Saunders Company