MANAGEMENT OF GASTROSCHISIS WITH CONCOMITANT JEJUNOILEAL ATRESIA

Background: The incidence of jejuno-ileal atresia in neonates concomit antly found to possess gastroschisis has been reported to be 5% to 25% . Initial treatment for this condition has not been well established. Methods: Thirteen newborns with gastroschisis and coexisting jejuno-il eal atresia, were identified and treated at our institution over the p ast 16 years (1978 through 1996). Patient characteristics at presentat ion, surgical therapy, and complications at extended follow-up were re viewed. Results: All neonates were preterm (mean gestational age, 35.2 +/- 2.0 weeks) and of low birth weight (2.1 +/- 0.4 kg). Atresia type s II, IIIa, IIIb, and IV were identified at the initial surgical proce dure in one, eight, one, and three patients respectively; however, one synchronous small bowel atresia went unrecognized. A primary anastomo sis was fashioned in 8 of 13 newborns, the creation of which did not i nfluence length of hospitalization, length of total parenteral nutriti on (TPN) requirement, complication rate, or survival; however, reopera tion was required in two of eight patients to mediate anastomotic comp lications. Atresia associated with intestinal gangrene or perforation was treated by primary anastomosis in three of six patients and the re maining three by enterostomy. Primary abdominal wall closure was possi ble in 10 of 13 patients; a Silon pouch was required in three. All nin e survivors (69%) displayed protracted small bowel dysfunction requiri ng TPN (mean TPN duration of 3.6 +/- 3.0 months; range, 1 to 11). Mort ality in four patients was a consequence of severe prematurity, Silon pouch wound sepsis, or TPN-induced cirrhosis. Conclusions: When techni cally feasible, restoration of intestinal continuity by primary anasto mosis is a reasonable treatment option in patients with coexisting gas troschisis and jejuno-ileal atresia, Favorable outcome is as much a fu nction of supportive care and parenteral nutrition as the type of surg ical repair performed for either the intestinal or the abdominal wall defect. J Pediatr Surg 33:885-888. Copyright (C) 1998 by W.B. Saunders Company.