-
BMC Gastroenterology Jul 2020Studies of microbiota composition of infants with small intestinal ostomy due to various etiologies are limited. Here, we characterized the intestinal microbiota of...
BACKGROUND
Studies of microbiota composition of infants with small intestinal ostomy due to various etiologies are limited. Here, we characterized the intestinal microbiota of neonates with ileostomy resulting from distinct primary diseases.
METHODS
Fifteen patients with necrotizing enterocolitis, eight patients with meconium peritonitis, and seven patients with Hirschsprung's disease were included in the study. The small intestinal microbiota composition in infants with ileostomy caused by these diseases was studied.
RESULTS
Microbial diversity in neonatal ileostomy fluid was generally low, and was dominated by members of the Proteobacteria and Firmicutes phyla. At the genus level, the most abundant were Klebsiella, Escherichia-Shigella, Streptococcus, Clostridium sensu stricto 1, Enterococcus, and Lactobacillus. Streptococcus and Veillonella are related to carbohydrate metabolism and immunity, and breastfeeding can increase the proportion of these potentially beneficial bacteria. The proportion of Bifidobacterium in the breastfeeding group was higher than that in the non-breastfeeding group, and incidence of colitis and sepsis was reduced in the breastfeeding group. The proportion of Bifidobacterium increased and incidence of colitis and sepsis decreased in the breastfeeding group compared with the non- breastfeeding group, but there was no significant difference. The increase in body weight in the breastfeeding group was observed to be higher than in the non-breastfeeding group.
CONCLUSIONS
Excessive Klebsiella and Escherichia-Shigella and low abundance of Streptococcus, Veillonella and Faecalibacterium suggests that the small intestinal microbiota is in an unhealthy state after ileostomy. However, Streptococcus, Faecalibacterium, and Veillonella species were frequently present, suggesting that expansion of these bacteria might assist the development of the immune system after surgery.
Topics: Bifidobacterium; Gastrointestinal Microbiome; Humans; Ileostomy; Infant; Infant, Newborn; Microbiota; Prognosis
PubMed: 32660555
DOI: 10.1186/s12876-020-01366-0 -
Frontiers in Pediatrics 2022Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to...
OBJECTIVE
Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to comprehensively analyze the multiple factors on complete enteral nutrition after primary anastomosis, and establish the convenient prediction model.
METHODS
We retrospectively collected reliable information in neonates with intestinal atresia form January 2010 to June 2022. The cox regression analysis was performed to select independent risk factors and develop nomogram. Subsequently, ROC curve, calibration curve and decision curve were drawn to thoroughly evaluate the accuracy and applicability of the model.
RESULTS
The predictors finally included in the model were gestational age, meconium peritonitis, distance from the anastomosis to the ileocecal region, diameter ratio of proximal to distal bowels, and time of initial feeding. The nomogram of predicting the probability of week 2, week 3 and week 4 was drawn and their area under the curve were 0.765, 0.785 and 0.747, respectively. Similarly, calibration and decision curve indicated that the prediction model had a great prediction performance.
CONCLUSION
The clinical value of predictive models can be recognized. The hope is that the predictive model can help pediatricians reduce hospital costs and parental anxiety.
PubMed: 36578664
DOI: 10.3389/fped.2022.1071056 -
International Journal of Surgery Case... Jul 2023Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature....
INTRODUCTION AND IMPORTANCE
Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature. Diagnosis requires histological confirmation, and treatment includes urgent laparotomy, resection of affected areas, and end-to-end anastomosis or creation of stomas. The work has been reported in line with the SCARE guideline criteria.
CASE REPORT
We present the case of a 31-week preterm newborn with prenatal diagnosis of polyhydramnios and non-immune fetal ascites. Radiological tests confirmed meconium peritonitis, and laparotomy was indicated. The patient had a torpid postoperative course requiring multiple surgeries due to intestinal occlusion and leakage of the anastomosis. Finally, he was discharged with good oral tolerance and bowel function. The anatomopathological examination reported the congenital absence of intestinal muscle with segmental and multifocal distribution.
CLINICAL DISCUSSION
Most neonatal cases share similar clinical features, and if SAIM is suspected during surgery, the suspicious areas should be resected to prevent future complications. The prognosis depends on the extent of the lesion, possibility of resecting affected segments, and concomitant pathologies.
CONCLUSION
In conclusion, this study aims to describe SAIM based on a clinical case and review of the literature. SAIM is a rare pathology that requires prompt diagnosis and treatment to prevent complications. Surgeons should consider resecting suspicious areas during surgery to prevent future complications.
PubMed: 37390581
DOI: 10.1016/j.ijscr.2023.108424 -
Wavy Floating Greater Omentum Findings Are Useful for Differentiating the Etiology of Fetal Ascites.Diagnostics (Basel, Switzerland) Feb 2021The greater omentum is an apron-like peritoneal mesothelial sheet that was described by ultrasound as a floating fluid-filled viscus in ascites during the fetal period....
The greater omentum is an apron-like peritoneal mesothelial sheet that was described by ultrasound as a floating fluid-filled viscus in ascites during the fetal period. To examine the association between the etiology of fetal ascites and ultrasound findings of the greater omentum, a retrospective study was conducted. Ultrasound findings of fetal omentum were defined as follows: (1) a cyst-like shape with a thin membrane observed as wavy in the ascites, (2) beside the stomach and below the liver, and (3) no blood flow noted on color Doppler. Eleven pregnancies had fetal ascites. A fetal greater omentum was confirmed in eight cases in which ascites were caused by non-peritonitis: fetal hydrops ( = 4), congenital cytomegalovirus infection ( = 2), idiopathic chylous ascites ( = 1), and unknown cause ( = 1). Of these eight cases, no abdominal surgical management was required in three live babies. However, a fetal greater omentum was not confirmed in all three cases of meconium peritonitis. It was suggested that the finding of the greater omentum can be an important clue for estimating the pathophysiological etiology of fetal ascites and helping with postnatal management. It should be reasonable to add the finding of the greater omentum to the detailed ultrasound examination checklist.
PubMed: 33671226
DOI: 10.3390/diagnostics11020326 -
Journal of Medical Ultrasound 2019Hydrops fetalis in association with meconium peritonitis is a rare condition, and the mechanism underlying hydropic changes has not been fully recognized. We present a...
Hydrops fetalis in association with meconium peritonitis is a rare condition, and the mechanism underlying hydropic changes has not been fully recognized. We present a case of fetal meconium peritonitis with hydrops and coagulopathy. Clinically, the cause of fetal disseminated intravascular coagulation is considered to be a consequence of a systematic inflammatory response based on progressive, but mild fetal anemia without other apparent triggers, thrombocytopenia, elevated white blood cell count and serum C reactive-protein, hypoalbuminemia, and increased vascular permeability. The infant was born at 32 weeks of gestation and survived after postnatal multidisciplinary treatment. Our experience suggests that recognition of this rare condition will enable early diagnosis and better clinical management for fetuses with meconium peritonitis.
PubMed: 31867196
DOI: 10.4103/JMU.JMU_25_19 -
Clinical Case Reports Aug 2022We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental...
We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental enterectomy with end-to-end anastomosis was performed. This case report highlights the diagnosis complexity of a fetal intestinal atresia associated with cystic fibrosis.
PubMed: 35949411
DOI: 10.1002/ccr3.5869 -
Medicine Jan 2017Benign pneumoperitoneum (BPPT) is defined as asymptomatic free intraabdominal air or as pneumoperitoneum without peritonitis. Symptomatic free air requires surgical...
INTRODUCTION
Benign pneumoperitoneum (BPPT) is defined as asymptomatic free intraabdominal air or as pneumoperitoneum without peritonitis. Symptomatic free air requires surgical anagement, but management of asymptomatic pneumoperitoneum is controversial. In this study, we investigate the diagnosis and treatment of BPPT in children.
CLINICAL FINDINGS
The clinical data of 9 pediatric patients with BPPT who were admitted to our hospital from January 2000 to January 2015 were retrospectively analyzed to summarize the diagnosis and treatment. Overall, 9 cases were included with 8 males and 1 female, aged from 4 days to 4 years. Among them there were 6 newborns (including 1 premature infant). Patients were all admitted to hospital with the major clinical symptom of abdominal distension, including 2 cases accompanied by tachypnea, 2 cases with vomiting, 1 case with diarrhea, and 2 cases with fever. No previous constipation or obstructive defecation existed. Six newborns had meconium defecation within 24 hours after birth. Physical examination revealed all patients with relaxed abdominal wall except 1 patient with abdominal distension had slight muscle stiffness and hyperactive bowel sounds. Abdominal X-ray suggested free air under the diaphragm in all cases.
INTERVENTIONS/OUTCOMES
All patients except for one case of laparotomy were conservatively treated and cured with fasting, infection prevention, rehydration, abdominocentesis, and close observation. Nine cases of patients were all discharged with no death occurrence. After discharge follow-up of 7 months to 6 years was conducted. There was no recurrence of similar symptoms, and children were in good growth and development.
CONCLUSION
The diagnosis of BPPT mainly relies on clinical symptoms in patient, careful abdominal examination, abdominal X-ray combined with abdominocentesis, and the exclusion of gastrointestinal perforation for confirmation. Conservative treatment can cure the disease. Attention should be paid to distinguish with surgical pneumoperitoneum to avoid unnecessary surgical exploration.
Topics: Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Laparotomy; Male; Physical Examination; Pneumoperitoneum; Radiography, Abdominal; Retrospective Studies; Treatment Outcome
PubMed: 28079808
DOI: 10.1097/MD.0000000000005814 -
Journal of Neonatal Surgery 2016To review nine-year experience in managing jejuno-ileal atresia (JIA) by primary resection and anastomosis and identify factors associated with reoperations. From...
To review nine-year experience in managing jejuno-ileal atresia (JIA) by primary resection and anastomosis and identify factors associated with reoperations. From April 2006 to May 2015, all consecutive neonates who underwent bowel resection and primary anastomosis for JIA were analyzed retrospectively. Patients with temporary enterostomy were excluded. Patient demographics, types of atresia, surgical techniques, need for reoperations, and long-term outcomes were investigated. A total of forty-three neonates were included, in which nineteen (44.2%) of them were preterm and fourteen (32.6%) were of low birth weight. Thirteen patients (30.2%) had jejunal atresia whereas thirty patients (69.8%) had ileal atresia. Volvulus, intussusception and meconium peritonitis were noted in 12, 8, and13 patients, respectively. Eight patients (18.6%) had short bowel syndrome after operation. Ten patients (23.3%) required reoperations from 18 days to 4 months after the initial surgery due to anastomotic stricture (n=1), adhesive intestinal obstruction (n=1), small bowel perforation (n=2) and functional obstruction (n=6). Prematurity and low birth weight were associated with functional obstruction leading to reoperation (p=0.04 and 0.01 respectively). The overall long-term survival was 97.7%. All surviving patients achieved enteral autonomy and catch-up growth at a median follow-up of 4.7 years. Long-term survival of JIA after primary resection and anastomosis are excellent. However, patients have substantial risk of early reoperations to tackle intraabdominal complications.
PubMed: 27896150
DOI: 10.21699/jns.v5i4.444 -
Ultrasound in Obstetrics & Gynecology :... Apr 2015
Topics: Adult; Female; Fetal Diseases; Humans; Imaging, Three-Dimensional; Infant, Newborn; Infant, Newborn, Diseases; Inflammatory Bowel Diseases; Meconium; Meconium Aspiration Syndrome; Peritonitis; Pregnancy; Ultrasonography, Prenatal
PubMed: 25565652
DOI: 10.1002/uog.14778 -
Cureus Jan 2023A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality...
A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality rate significantly. We presented a case of a neonate with abdominal distension and non-passage of meconium who experienced respiratory distress and was taken for exploratory laparotomy at a tertiary care center due to suspected bowel perforation. The neonate was diagnosed with a meconium pseudocyst intraoperatively as maternal ultrasound and ultrasound of the abdomen of the neonate after birth failed to make a definitive diagnosis; even an X-ray abdomen did not reveal pathognomonic egg-shell calcification. An interesting aspect of this case is the mother's complex obstetric history, which compelled us to conjecture whether it was possible to predict the chances of meconium peritonitis and take steps to prevent it. It must be noted that, despite rigorous research, the researchers could not find reliable literature co-relating the obstetric history of the mother with the formation of a meconium pseudocyst in the neonate.
PubMed: 36788879
DOI: 10.7759/cureus.33625