Complex gastroschisis: Clinical spectrum and neonatal outcomes at a referral center

Laje, Pablo; Fraga, María V.; Peranteau, William H.; Hedrick, Holly L.; Khalek, Nahla; Gebb, Juliana; Moldenhauer, Julie S.; Johnson, Mark P.; Flake, Alan W.; Adzick, N. Scott

doi:10.1016/j.jpedsurg.2018.03.011

Cited by 27 publications

(38 citation statements)

References 23 publications

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“…The incidence of hiatus hernia in patients with complex gastroschisis has been reported as 18.9% [37], which is similar to the general pediatric population referred for upper endoscopy [38]. In the same cohort of patients, 37.9% of cases with complex gastroschisis underwent fundoplication for severe GERD, half of them also had a hernia repair [38].…”

Section: Impact Of the Distorted Anatomy On Gerdmentioning

confidence: 64%

Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Rybak

Sethuraman

Nikaki³

et al. 2020

Nutrients

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Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options.

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Section: Impact Of the Distorted Anatomy On Gerdmentioning

confidence: 64%

Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Rybak

Sethuraman

Nikaki³

et al. 2020

Nutrients

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“…Usually, gastroschisis is an isolated malformation, and affected neonates have a good outcome with an overall survival rate greater than 90% [5][6][7]. However, 17% of gastroschisis are complicated with intestinal atresia, perforation, necrotic segments, or volvulus and thus become complex gastroschisis [8,9]. One of the most feared complications is the "vanishing gastroschisis" (VG).…”

Section: Introductionmentioning

confidence: 99%

Vanishing Gastroschisis with a Favorable Outcome after a 3-Year Follow-Up: A Case Report and Literature Review

Rached

Sananès

Kauffmann-Chevalier

et al. 2020

Case Reports in Obstetrics and Gynecology

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Vanishing gastroschisis (VG) is a severe complication of gastroschisis with a high mortality rate. We report here a case of VG with a favorable outcome after a 3-year follow-up. A 26-year-old primigravida woman was referred to Strasbourg University Hospital because her fetus was diagnosed with an isolated gastroschisis at 13-week gestation. The ultrasound evolution was marked by a progressive closure of the abdominal wall defect from 19-week gestation and the appearance of dilated intra-abdominal loops. The child was born with a closed abdominal wall except a small remnant at the level of the former gastroschisis orifice. Explorative laparotomy revealed extensive midgut atresia with only 50 cm of remaining midgut. A jejunocolic anastomosis was performed. The child is now 3 years old and has a favorable outcome with only 2 nights a week of parenteral nutrition. A total of 39 cases of VG type D from Perrone et al. classification are described in the literature from 1991 to 2019, among which 19 (48.7%) are alive at the time of publication but only 4 cases are described with a long-term follow-up of 3 years or more. This is the fifth case described with a favorable evolution after 3-year follow-up.

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“…La gastrosquisis puede presentarse como una malformación aislada (gastrosquisis simple) o en asociación con otras anomalías o complicaciones gastrointestinales, como atresia intestinal, divertículo de Meckel, síndromes de malrotación, duplicación intestinal, perforación, necrosis o vólvulo intestinal (gastrosquisis compleja). El tiempo de interrupción del embarazo, la vía de elección y el mecanismo de reducción, y los criterios ultrasonográficos de pronóstico continúan siendo objeto de estudio (2)(3)(4)(5)(6) .…”

Section: Introductionunclassified

Índice vena/arteria de vasos mesentéricos en casos de gastrosquisis: nueva herramienta pronóstica

Olavarría

Larrazábal

Mora

et al. 2019

Rev peru ginecol obstet.

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Objetivo. Evaluar mediante flujometría Doppler y de manera simultánea el flujo de la arteria y vena mesentérica superior en casos normales y en aquellos portadores de gastrosquisis, como criterio adicional en el pronóstico. Métodos. Se determinó mediante flujometría Doppler el índice venoso/arterial, obteniendo los valores de referencia de los vasos mesentéricos superiores, en un grupo de 60 fetos sanos con 30 a 34 semanas de gestación y 15 casos portadores de gastrosquisis. Se obtuvo la onda de velocidad de flujo (OVF) simultáneamente de la arteria y de la vena mesentérica superior, con ángulo de insonación menor a 60°; la velocidad de la vena fue dividida entre el pico sistólico de la arteria y calculado el índice porcentual entre las velocidades de ambos vasos. El equipo utilizado fue un MyLab Twice de Esaote con transductor convexo de 3,5 MHz. Resultados. El valor del índice veno/arterial de los vasos mesentéricos superiores en el grupo control fue 26% ± 6 (2DE). En 12 casos de gastrosquisis, el índice se mantuvo dentro de los valores de referencia y con índice pronóstico favorable para reducción primaria (9 con técnica de Svelitza y 3 con reducción primaria neonatal inmediata) y, en tres casos, el índice porcentual veno/arterial se encontró por debajo del 20%, (1%, 14% y 16%), con resultados desfavorables. En el caso con mayor compromiso, no pudo detectarse flujo venoso y requirió de resección amplia, con síndrome de intestino corto y fallecimiento a los 6 meses. Conclusiones. El índice de perfusión de las asas intestinales evisceradas, estudiado mediante la relación porcentual entre las velocidades de la vena y velocidad máxima de la arteria mesentérica superior, podría ser considerada como un complemento pronóstico en las condiciones de flujos aferentes y eferentes en que se encuentran dichas asas, en los casos de gastrosquisis.

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Complex gastroschisis: Clinical spectrum and neonatal outcomes at a referral center

Cited by 27 publications

References 23 publications

Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Vanishing Gastroschisis with a Favorable Outcome after a 3-Year Follow-Up: A Case Report and Literature Review

Índice vena/arteria de vasos mesentéricos en casos de gastrosquisis: nueva herramienta pronóstica

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