COMBINATION OF PATCH, DRAIN, AND WAIT AND HOME TOTAL PARENTERAL-NUTRITION FOR MIDGUT VOLVULUS WITH MASSIVE ISCHEMIA NECROSIS/

The sucessful use of a combination of ''patch. drain, and wait'' (PDW) and home total paraenteral nutrition. (TPN) in the management of a ca se of acute, catastrophic midgut volvulus in a 2-year-11-month-old boy with near-total ischemia/necrosis of his small intestine is reported. The PDW approach to the highly effective management of acute midgut i schemia/necrosis in infancy and childhood (necrotizing enterocolitis a nd midgut volvulus) involves maximum gut salvage by avoidance of resec tion, stoma formation, or both through the use of extensive peritoneal cavity drainage by Penrose drains, TPN, and broad-spectrum antibiotic s. The extensive peritoneal drainage fosters capture of enteric fistul as with the formation of enterostomies at drain exit sites, while adhe sions and ischemia/inflammation-induced hypervascular obliteration of the peritoneal cavity diminish the potential for peritonitis (no perit oneal cavity, no peritonitis) and facilitate impressive salvage of see mingly hopelessly lost ischemic/necrotic gut (a simulation of the in u tero ischemic gut process leading to atresias and some varying, but ge nerally mild, gut loss) while simultaneously contributing to the resor ption of absolutely non-salvageable gut and the creation of a remarkab ly clean and adhesion-free peritoneal cavity resembling that of a newb orn infant with midgut intestinal atresia.