Gastrointestinal bleeding as a complication of serial transverse enteroplasty

Abstract

Purpose Serial transverse enteroplasty (STEP) lengthens and tapers bowel in patients with intestinal failure and has a generally low complication profile. Evaluation and treatment of serious gastrointestinal bleeding (GIB) in three STEP patients is described. Methods Records of patients participating in an interdisciplinary intestinal rehabilitation program were reviewed to identify those who underwent STEP and had GIB necessitating red blood cell transfusion. Results Of 296 patients, 23 underwent STEP and 3 (13%) had subsequent GIB requiring transfusion. Underlying diagnoses were multiple atresias/intrauterine volvulus, gastroschisis, and gastroschisis with volvulus. STEP was performed at ages ranging from 3–5 months, using 3–8 stapler firings with an increase in mean bowel length from 23 to 45 cm. GIB was noted at 10–33 months post-op and resulted in 2–7 transfusions per patient over a period of 3–16 months. Gastrointestinal endoscopic evaluation demonstrated ulcers adjacent to the staple lines in two patients. Both had improvement of GIB with enteral antibiotics, sulfasalazine, topical enteral steroids and, ultimately, a period of bowel rest. The third patient had histological evidence of eosinophilic enteritis and was treated sequentially with antibiotics, sulfasalazine, enteral steroids, and an elemental diet. In all three, hemoglobin levels improved despite persistent occult bleeding. Conclusions Significant GIB is a potential late complication of STEP. Endoscopy identified the underlying source of GIB in all three patients. A combination of enteral antibiotics, anti-inflammatory medications, and bowel rest was effective in the treatment of post-STEP GIB, without the need for additional bowel resection.

Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

“…6 7 8 Infrequent but worrisome, the apparition of ulcerations along the staple line months or years after surgery has been described and leads to chronic gastrointestinal bleeding and transfusion requirement. 7 12 13 14 Of unknown origin, as is in our case, they appear more in the distal staple lines, closer to the colonic anastomosis, suggesting bacterial overgrowth as one of the possible etiologic factors. 12 14…”

Successful treatment of Henoch-Schönlein purpura-associated hematochezia in a child with hemophilia A: a case report

“…Corticosteroids, given early in the course of illness, seem to produce consistent benefits for gastrointestinal bleeding, in children suffering from HSP [ 18 ]. Remarkably, our patient also had congenital malrotation of the intestine, which could increase the risk of gastrointestinal bleeding [ 21 , 22 ].…”

Success of Serial Transverse Enteroplasty in an Adult With Extreme Short Bowel Syndrome: A Case Report

“…Studies have revealed that patients underwent STEP may develop gastrointestinal hemorrhage. 16 A single institution series report on the STEP procedure by Ching et al 17 revealed that 3 out of the 16 patients followed had gastrointestinal bleed that did not require reoperation. The underlying cause for these bleeds was not described.…”