Детская хирургия. Журнал им. Ю.Ф. Исакова. 2021; 25: 51-56
Лапароскопическое лечение пилорической атрезии у новорождённого
https://doi.org/10.18821/1560-9510-2021-25-1-51-56Аннотация
Введение. Атрезия привратника относится к наиболее редким хирургическим заболеваниям у новорождённых. Лапаротомия является самым распространённым доступом, предназначенным для коррекции этой аномалии. В современной научной литературе существует только одно сообщение об эндохирургическом лечении пилорической атрезии. Представленный в настоящем исследовании случай лапароскопической коррекции атрезии выходного отдела желудка является следующим упоминанием об успешном лечении этого состояния.
Материал и методы. Клинический случай представлен новорождённым мальчиком, у которого пренатальное ультразвуковое исследование на 31-й неделе беременности выявило полигидрамнион и увеличенный в размерах желудок. Масса тела при рождении 2660 г. В первые часы жизни у ребенка отмечались симптомы высокой кишечной обструкции в виде рвоты содержимым желудка. Постнатальное ультразвуковое и рентгеновское исследование выполнено на 2-е сутки жизни, проведена оценка морфологической формы аномалии и установлен I тип атрезии, представленный мембраной. Была выполнена лапароскопическая мембранэктомия с пилоропластикой по Гейнеке–Микуличу (Heineke–Mikulicz). В финальной части научной работы были исследованы ранние и отдалённые результаты операции.
Результаты. Длительность операции составила 70 мин. Послеоперационный период протекал без осложнений. Старт энтерального питания – на 3-й день после операции. Полная энтеральная диета стала возможна на 7-е сутки. Новорождённого выписали из больницы на 9-е послеоперационные сутки. Гистологическое исследование подтвердило диагноз мембранозной формы атрезии привратника. При наблюдении на протяжении 12 мес не было обнаружено осложнений, связанных с хирургической процедурой.
Заключение. Описание случая лапароскопического лечения I типа пилорической атрезии у новорождённого расширяет границы использования лапароскопии в педиатрической практике.
Список литературы
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
Russian Journal of Pediatric Surgery. 2021; 25: 51-56
Laparoscopic treatment of pyloric atresia in a newborn
https://doi.org/10.18821/1560-9510-2021-25-1-51-56Abstract
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.
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
