Laparoscopic treatment of pyloric atresia in a newborn



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Pyloric atresia is one of the rarest surgical diseases in newborns. Laparotomy is the most common modality for correcting this abnormality. In modern scientific literature, there is only one report on the endosurgical treatment of pyloric atresia. The case of laparoscopic correction of gastric outlet atresia presented in this study is one more reference to the successful care of this condition.

Material and methods. The presented clinical case is a newborn boy in whom a prenatal ultrasound examination at the 31st week of gestation revealed polyhydramnios and an enlarged stomach. The baby’s birth weight was 2660 grams. In the first hours of life, the child showed symptoms of high intestinal obstruction in the form of gastric content vomiting. Postnatal ultrasound and X-ray examination confirmed the diagnosis of pyloric atresia. During laparoscopy, performed on the 2nd day of life, the morphological type of anomaly was examined, and the type I atresia of membranous form was established. A laparoscopic membranectomy with Heineke–Mikulicz pyloroplasty was performed. In the final part of this research, early and late outcomes of the performed surgical treatment were analyzed.

Results. The surgery lasted for 70 min. Postoperative period was uneventful. Enteral nutrition started on day 3 after the surgery. A complete enteral diet was possible on day 7. The newborn patient was discharged from the hospital on the 9th postoperative day. Histological examination confirmed the pyloric atresia of membranous type. During 12-month follow-up, no complications associated with the surgical procedure were seen.

Conclusion. The described case of laparoscopic treatment of type I pyloric atresia in a newborn expands laparoscopy application in pediatric practice.

About the authors

Yu. A. Kozlov

Ivano-Matreninskaya Municipal Pediatric Clinical Hospital; Irkutsk State Medical Academy of Continuing Education; Irkutsk State Medical University

Author for correspondence.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X

Yury А. Kozlov, head of department of neonatal surgery; professor of the department of pediatric surgery; professor of the department of pediatric surgery

Irkutsk, 664009, Russian Federation

Irkutsk, 664049, Russian Federation

Irkutsk, 664003, Russian Federation

Россия

A. A. Rasputin

Ivano-Matreninskaya Municipal Pediatric Clinical Hospital; Irkutsk State Medical Academy of Continuing Education

Email: fake@neicon.ru
ORCID iD: 0000-0002-5690-790X

Irkutsk, 664009, Russian Federation

Россия

K. A. Koval'kov

Kuzbass regional Children's Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-6126-4198

Kemerovo, 650056, Russian Federation

Россия

S. S. Poloyan

Krasnoyarsk regional Clinical Center for Maternal and Child Health

Email: fake@neicon.ru
ORCID iD: 0000-0001-7042-6646

Krasnoyarsk, 660074, Russian Federation

Россия

P. Zh. Baradieva

Ivano-Matreninskaya Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5463-6763

Irkutsk, 664009, Russian Federation

Россия

D. A. Zvonkov

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-7167-2520

Irkutsk, 664003, Russian Federation

Россия

Ch. B. Ochirov

Ivano-Matreninskaya Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-6045-1087

Irkutsk, 664009, Russian Federation

Россия

V. S. Cheremnov

Ivano-Matreninskaya Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-6135-4054

Irkutsk, 664009, Russian Federation

Россия

References

  1. Gerber B.C., Aberdeen S.D. Pre-pyloric diaphragm, an unusual abnormality. Arch Surg. 1965; 90: 472-5.
  2. Cook R.C.M., Rickham P.P. Gastric Outlet Obstruction in Neonatal Surgery (ed 2). London, England, Butterworths: 1978; 335-8.
  3. Adashi E.Y., Louis F.J., Vasquez M. An unusual case of epidermolysis bullosa hereditarialetalis with cutaneous scaring and pyloric atresia. J Pediatr. 1980; 96: 443-6. https://doi.org/10.1016/s0022-3476(80)80695-0
  4. Müller M., Morger R., Engert J. Pyloric atresia: report of four cases and review of the literature. PediatrSurg Int. 1990; 5(4): 276–9.
  5. Ilce Z., Erdogan E., Kara C., Celayir S., Sarimurat N., Senyüz O.F., Yeker D. Pyloric atresia: 15-year review from a single institution. Journal of Pediatric Surgery. 2003; 38(11), 1581–4. https://doi.org/10.1016/s0022-3468(03)00565-7
  6. Bass J. Pyloric atresia associated with multiple intestinal atresia and immune deficiency. J PediatrSurg. 2002; 37: 941-2.
  7. Mboyo A., Clermidi P., Podevin G., Patkowski D., Baglaj M., Gerus S., Robert M. Neonatal gastric outlet obstruction by isolated pyloric atresia, an often forgotten diagnosis. Acta Chirurgica Belgica. 2016; 116(2): 89–95.
  8. Gehwolf P., Hechenleitner P., Sanal M., Profanter C., Häussler B., Härter B. Treatment of Congenital Gastric Outlet Obstruction due to a Web. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2019; 29(3): 207–11. https://doi.org/10.1097/sle.0000000000000658
  9. Son T.N., Hoan V.X. Laparoscopic Management of Pyloric Atresia in a Neonate with EpidermolysisBullosa. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2013; 23(7): 649–50. https://doi.org/10.1089/lap.2013.0189
  10. Mishalany H.G., Idriss Z.H., Der Kaloustian V.M. Pyloroduodenal atresia (diaphragm type): an autosomal recessive disease. Pediatr 1978; 62(3): 419-21
  11. Gedde-Dahl T.Jr., Anton-Lambrecht I. Principles and Practice in Medical Genetics. New York, NY: Churchill-Livingston; 19811.
  12. Al-Salem A.H., Abdulla M.R., Kothari M.R., Naga M. Congenital pyloric atresia, presentation, management, and outcome: A report of 20 cases. Journal of Pediatric Surgery. 2013; 49(7): 1078–82. https://doi.org/10.1016/j.jpedsurg.2013.10.009
  13. Chang C.H., Perrin E.V., Bove K.E. Pyloric atresia associated with epidermolysis bullosa: Special reference to pathogenesis. Pediatr Pathol. 1983; 1: 449-57. https://doi.org/10.3109/15513818309025877
  14. Grosfeld J.L., Molinari F., Chaet M., Engum S.A., West K.W., Rescorla F.J., Scherer L.R. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery. 1996; 120: 650-6. https://doi.org/10.1016/s0039-6060(96)80012-2
  15. Okoye B.O., Parikh D.H., Buick R.G., Landa A.D. Pyloric atresia: five new cases, a new association, and a review of the literature with guidelines. J Pediatr Surg. 2000; 35: 1242–5. https://doi.org/10.1053/jpsu.2000.8762
  16. Lépinard C., Descamps P., Meneguzzi G., et al. Prenatal diagnosis of pyloric atresia-junctionalepidermolysisbullosa syndrome in a fetus not known to be at risk. Prenat Diagn. 2000; 20: 70-5. https://doi.org/10.1002/(sici)1097-0223(200001)20:1%3C70::aid-pd747%3E3.0.co;2-e
  17. Yu D.C., Voss S.D., Javid P.J., Jennings R.W., Weldon C.B. In utero diagnosis of congenital pyloric atresia in a single twin using MRI and ultrasound. J Pediatr Surg. 2009; 44: E21-4. https://doi.org/10.1016/j.jpedsurg.2009.08.016
  18. Otjen J.P., Iyer R.S., Phillips G.S., Parisi M.T. Usual and unusual causes of pediatric gastric outlet obstruction. Pediatric Radiology. 2012; 42(6): 728–37.
  19. Merrow A.C., Frischer J.S., Lucky A.W. Pyloric atresia with epidermolysis bullosa: fetal MRI diagnosis with postnatal correlation. Pediatr Radiol. 2013; 43: 1656–61.
  20. Dessanti A., Di Benedetto V., Iannuccelli M., Balata A., CossuRocca P., Di Benedetto A. Pyloric atresia: a new operation to reconstruct the pyloric sphincter. Journal of Pediatric Surgery. 2004; 39(3): 297–301. doi: 10.1016/j.jpedsurg.2003.11.03

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies