Abstract
The successful use of a combination of “patch, drain, and wait” (PDW) and home total parenteral nutrition (TPN) in the management of a case of acute, catastrophic midgut volvulus in a 2-year-11-month-old boy with near-total ischemia/necrosis of his small intestine is reported. The PDW approach to the highly effective management of acute midgut ischemia/necrosis in infancy and childhood (necrotizing enterocolitis and midgut volvulus) involves maximum gut salvage by avoidance of resection, stoma formation, or both through the use of extensive peritoneal cavity drainage by Penrose drains, TPN, and broad-spectrum antibiotics. The extensive] peritoneal drainage fosters capture of enteric fistulas with the formation of enterostomies at drain exit sites, while adhesions and ischemia/inflammation-induced hypervascular obliteration of the peritoneal cavity diminish the potential for peritonitis (no peritoneal cavity, no peritonitis) and facilitate impressive salvage of seemingly hopelessly lost ischemic/necrotic gut (a simulation of the in utero ischemic gut process leading to atresias and some varying, but generally mild, gut loss) while simultaneously contributing to the resorption of absolutely non-salvageable gut and the creation of a remarkably clean and adhesion-free peritoneal cavity resembling that of a newborn infant with midgut intestinal atresia.
References
Dorney SFA, Ament ME, Berquist WE, et al. (1985) Improved survival in very short bowel of infancy with use of long-term parenteral nutrition. J Pediatr 107: 521–527
Laufman H, Martin WB, Method H, et al. (1949) Observations in strangulation obstruction: II. The fate of sterile devascularized intestine in the peritoneal cavity. Arch Surg 59: 550–564
Louw JH, Barnard CN (1955) Congenital intestinal atresia. Observations on its origin. Lancet 2: 1065–1067
Moore TC (1991) Management of midgut volvulus with extensive necrosis by “patch, drain and wait” in early infancy and childhood. Pediatr Surg Int 6: 313–317
Moore TC (1989) Management of necrotizing enterocolitis by “patch, drain and wait.” Pediatr Surg Int 4: 110–113
Moore TC (1994) Challenges in pediatric surgery. Boca Raton, FL, pp 71–108, CRC Press
Moukarzel AA, Haddad I, Ament ME, et al. (1994) 230 patient years of experience with home long-term parenteral nutrition in childhood: natural history and life of central venous catheters. J Pediatr Surg 29: 1323–1327
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Moore, T.C., Ng, C.S., Fonkalsrud, E.W. et al. Combination of “patch, drain, and wait” and home total parenteral nutrition for midgut volvulus with massive ischemia/necrosis. Pediatr Surg Int 12, 208–210 (1997). https://doi.org/10.1007/BF01350006
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DOI: https://doi.org/10.1007/BF01350006