Jht. Waldhausen et Rs. Sawin, IMPROVED LONG-TERM OUTCOME FOR PATIENTS WITH JEJUNOILEAL APPLE PEEL ATRESIA, Journal of pediatric surgery, 32(9), 1997, pp. 1307-1309
Background/Purpose: Although apple peal intestinal atresia is a rare l
esion associated with significant morbidity and high mortality, the au
thors have seen no deaths since 1983. Similar success has rarely been
reported, and there are no reports of long-term follow-up. This study
examines the short-term and long-term complications and outcome for th
ese children, critiques our evolution in care, and gives current recom
mendations for therapy. Methods: A retrospective review of 12 patients
over 11 years was conducted. Perinatal history and operative and peri
operative management were examined and end results and complications u
sing different management plans compared. Long-term outcome was determ
ined through clinic follow-up. Results: Mean follow-up was 5.1 years.
Children had a mean 61.4 cm of total small bowel. Seven patients under
went a primary anastomosis and five had enterostomies. The proximal je
junum was tapered, plicated, resected or left intact. Eleven children
required gastrostomy tubes. All children required total parenteral nut
rition. Full enteral feeding was achieved in all children, but three r
equired gastrostomy supplementation. Three patients who had enterostom
ies suffered bowel obstruction, two with dilated, dysmotile proximal j
ejunum required subsequent tapering. Eight children maintained a growt
h curve between the 5th and 50th percentile. None have short bower phy
siology, and all have achieved acceptable bowel function. Conclusions:
(1) Total parenteral nutrition is essential for initial nutritional m
anagement. (2) Use of an enterostomy leads to an increased incidence o
f complications. (3) The dilated proximal bowel should be resected, ta
pered, or plicated, and a primary anastomosis should be performed. (4)
Gastrostomy tubes are necessary for initial management, (5) Early mor
bidity is common, though excellent long-term outcome and normal growth
and development are expected. Copyright (C) 1997 by W.B. Saunders Com
pany.