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I n t e r n a t i o n a l C o n f e r e n c e o n
Physicians, Surgeons and
Case Reports
November 19-20 , 2018
Par i s , France
Medical Case Reports
ISSN: 2471-8041
PSCR 2018
A
case of duplication cyst presented with almost fully gangrenous midgut
in a neoborn. Gastrointestinal (GI) duplications are rare congenital
malformations that may vary greatly in presentation, size, location,
and symptoms. GI duplications may present as solid or cystic swelling,
intussusception, perforation, or GI bleeding or very rare volvulus. In our case,
a neoborn presented with intestinal obstruction and investigations pointed to
intestinal obstruction due to duplication cyst. Laparotomy findings showed
near total midgut volvulus causing strangulation with subsequent almost fully
gangrenous bowel and a large duplication cyst at the proximal jejunum. Bowel
colour did not improve after about one hour of de-rotation, warm fomentation
and increased O
2
supply. Depending on specific criteria, we resected only
the duplication cyst and we did primary intestinal anastomosis. Abdomen
was closed without a drain. We put specific parameters for post-operative
observation and explained to parents that we will observe and may need re-
laparotomy after 48- 72 hours if there is deterioration of the vitals, deranged
investigation parameters and/or worsening of general condition of the baby.
Baby improved and bowel survived. Barium meal follows through after one
year showed normal bowel distribution and peristalsis. This is the first case
report in such pathology and may change the view of management of near fully
gangrenous bowel not improving with intraoperative manipulation.
Discussion:
We reviewed articles on duplication cyst and its complications,
Also articles in midbowel gangrene and its management and the prognosis.
Conclusion:
The criteria which were used in taking the decision to close the
abdominal cavity, were the first time to be used in such highly compromised,
ischemic bowel: arterial pulsation of the mesenteric arteries started to be felt;
the colour still dark but spots of pinkish discolouration appeared (Figure1);
little venous blood ooze, at the cut edges of the intestine, no need to wait
for arterial bleeding; weak or no clear peristalsis; the bowel doesn’t look
mummified or 100% dead on benching it. The use of post-operative monitoring
method is commonly used in critical patients. Full counselling to the parents in
all points is a must. The success of this case deserves applying these criteria
in cases of almost fully gangrenous bowel especially in such cases because
removal of the affected midgut bowel will end in short bowel syndrome with
its known morbidity and mortality. Also keeping the bowel in the abdominal
cavity without full closure will add morbidity and will prevent the full natural
environment of the bowel for survival, which I think was the main factor for the
bowel to regain its viability in our case. We need more cases to prove these
criteria in such conditions.
Biography
Dr Hamid Qoura, is Graduated fromKasr El-Aini medical school,
(Faculty of medicine Cairo University) 1983. Finished his
Master degree from the same college. Had MRCS from Ireland
and FEBPS from Glasgow. Had a diploma in laparoscopic
surgery from Strasbourg, France. He is working at present as
a consultant and HOD of Pediatric Surgery in Nizwa Hospital,
Oman. He published more than 10 papers in reputed Journals.
Has special interest in laparoscopic surgery. He is the first one
did real single port laparoscopic umbilical hernia, epigastric
hernia and divarication of recti repair. And can do throus the
same port inguinal hernias of the same patient.
qora21@gmail.comCan almost-fully gangrenous midgut, completely survive?
Hamid Qoura, Abdulrasheed, Ahmed Aboshosha, Moenes A L
Karim and Adil Mohamed
Nizwa Hospital, Oman
Hamid Qoura, Med Case Rep. 2018, Volume:4
DOI: 10.21767/2471-8041-C2-005