Clinical and experimental results of removing the large intestine soon after birth.

Abstract

. (1973). Archives of Disease in Childhood, 48, 121. Clinical and experimental results of removing the large intestine soon after birth. A boy from whom the distal 7 cm of the ileum, ileocaecal valve, caecum, and the ascending, transverse, and most of the pelvic parts of the colon had been removed in the neonatal period, was reinvestigated when he was 9j years old. He had developed normally and was constipated.An almost identical operation was carried out on 9 piglets when they were 10 days old. After early difficulties with diarrhoea, 5 of these animals became functionally mature even if rather small. As adults, the intestinal tracts behaved normally. No evidence of hypertrophy was found in any part of the small intestine or rectum.Gangrene of the bowel is a rare but recognized complication of exchange transfusion soon after birth (McCandless, 1971(McCandless, , 1972Hey, Ellis, and Walker, 1972). Complete removal of the caecum and colon for this cause is most uncommon in the neonatal period. The present paper describes the metabolic investigation of a neonate soon after such a resection and subsequently nearly 10 years later, and an experimental study of the results of a similar operation in newborn pigs. The size of piglets makes them satisfactory models for neonatal surgery and they have been used also by Rickham (1967), as have larger pigs by Brown (1938). Patient and experimental animalsThe boy was bom at term after a normal pregnancy and weighed 2-92 kg. On the third day of life his serum bilirubin was 29 mg/100 ml and an exchange transfusion was performed. 24 hours later his abdomen was distended with gas but was not tender, and fluid levels were not seen in the upright x-ray. On the fifth day an indefinite tender mass was felt in the right lower quadrant of the abdomen and in the right flank. At laparotomy patches of gangrene were found in the caecum, and the ascending, transverse, descending, and pelvic parts of the colon. The distal 7 cm of the ileum and the caecum and colon to the terminal part of the pelvic colon were resected, and the end of the ileum was anastomosed to the stump of the distal pelvic colon. No intravenous fluid was given, but 36 hours after operation he was given 5 ml of 5% glucose hourly by mouth for 6 hours; 250% breast milk in water was Received 12 June 1972. then given, and was gradually increased in strength and quantity. His progress was very satisfactory and a balance study was made between the 12th and 15th days of life.When the boy was 26 days old he brought up a large vomit of thick stale curd and some bile-stained fluid, and did so repeatedly during the following night but without great abdominal distension. An upright x-ray revealed multiple 'levels', and at laparotomy the cause was found to be adhesions which were divided; his progress was satisfactory till he was discharged. A brief report of the boy at this stage was given by Wilkinson, Hughes, and Toms (1963).He was reinvestigated when he was 9 years and 6 months old. His height was 135-5 cm and his weight 27-2 k...