- Title
- Bowel scintigraphy identifies segmental dysmotility prior to stoma closure
- Creator
- Cassey, John Gerard; Liebenberg, Paul Heinrich; Nightingale, Scott; Gupta, Sandeep Kumar
- Relation
- Journal of Pediatric Surgery Case Reports Vol. 64, Issue January 2021, no. 101695
- Publisher Link
- http://dx.doi.org/10.1016/j.epsc.2020.101695
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2021
- Description
- Introduction: Stoma closure surgery (SCS; restoring intestinal continuity) in children is associated with high post-surgical complication rates with no established preventive strategies. Although many of these complications can be directly or indirectly attributable to bowel obstruction, no anatomical obstructive pathology is found in the majority. Intestinal dysmotility in children with no prior surgery is a well-known entity, which can lead to clinical features similar to anatomical obstruction. It is not known if a similar pathology could be the reason for SCS complications as well. Method & Results: We retrospectively reviewed five consecutive cases in our institution between 2016 and 2018, where scintigraphy was utilized to assess bowel motility prior to SCS. The radiotracer is administered via stoma or per anum, admixed with barium for anatomical assessment. Three children had failed prior attempts at SCS (underlying disease: spontaneous neonatal perforation, necrotizing enterocolitis, colonic atresia). A fourth patient, with gastroschisis, had ongoing obstruction despite multiple stricture resections. In all these patients, a dysmotile section of bowel was identified on scintigraphy in the distal small or large bowel and was resected. Three had excellent post-surgical follow up with no complications; one patient died in the immediate postoperative period likely from unrelated cause. A fifth child had a normal bowel motility study prior to SCS and had an uneventful follow up. Conclusions: Areas of segmental dysmotility in the distal gut may be the primary cause of post-SCS complications. Using a novel approach of assessing bowel motility using scintigraphy, such areas can be identified pre-operatively and resected, leading to reduced post-SCS complications. We recommend further investigation and validation in a larger prospective study.
- Subject
- stomal closure; dysmotility; post-operative complication
- Identifier
- http://hdl.handle.net/1959.13/1456673
- Identifier
- uon:45251
- Identifier
- ISSN:2213-5766
- Rights
- © 2020 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
- Language
- eng
- Full Text
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