Management of midgut volvulus with extensive necrosis by “patch, drain, and wait” in early infancy and childhood

Abstract

Midgut volvulus with extensive intestinal necrosis in the newborn period and in early infancy and childhood presents a difficult therapeutic dilemma of how to control sepsis and preserve a maximum and life-sustaining amount of large and small intestine. This problem is similar to that faced in cases of necrotizing enterocolitis with extensive intestinal ischemia and necrosis. The successful use of the “patch, drain, and wait” approach in necrotizing enterocolitis suggested its potential usefulness in midgut volvulus with similarly extensive necrosis in early life [7]. The basic principles of this approach involve maximum bowel salvage by avoidance of both resection and enterostomy; extensive bilateral Penrose drainage of the peritoneal cavity to provide an exit for sepsis and debris for peritonitis control; and “de facto” enterostomies for potential enteric fistula capture, gastrostomy for upper gastrointestinal tract venting and decompression, and Broviac catheter placement for long-term hyperalimentation. Three cases involving the successful use of this approach are reported.