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1.
Arch Pediatr ; 28(3): 226-233, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33674188

ABSTRACT

INTRODUCTION: Multiple intestinal atresia (MIA) is a rare cause of neonatal intestinal obstruction. To provide an overview of the current prenatal, surgical, and nutritional management of MIA, we report our experience and a literature review of papers published after 1990. METHODS: All cases of isolated MIA (non-hereditary, not associated with apple-peel syndrome or gastroschisis) treated at our institution between 2005 and 2016 were reviewed and compared with cases found in the literature. RESULTS: Seven patients were prenatally suspected of having intestinal obstruction and were postnatally diagnosed with MIA, with a mean 1.7 (1-2) resections-anastomoses (RA) and 6 (1-10) strictureplasties performed, resulting in a mean resected bowel length of 15.1cm (15-25 cm). Median time to full oral feed was 46 days (14-626 days). All patients were alive and none had orality disorder after a mean follow-up of 3.1 years (0.2-8.1 years). Three surgical strategies were found in the literature review: multiple RA (68%, 34/50) including Santulli's technique in four of 34 (12%) and anastomoses over a transanastomotic tube (32%, 16/50), with a 98% survival rate, and short-bowel syndrome for only two patients. CONCLUSION: Bowel-sparing surgery and appropriate medical management are key to ensuring a favorable nutritional and gastrointestinal outcome and a good prognosis. Prenatal assessment and standardization of the surgical course of treatment remain challenging.


Subject(s)
Intestinal Atresia/therapy , Perinatal Care/standards , Quality Improvement , Combined Modality Therapy , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/standards , Female , Follow-Up Studies , Humans , Infant, Newborn , Intestinal Atresia/diagnosis , Male , Nutritional Support/methods , Nutritional Support/standards , Perinatal Care/methods , Pregnancy , Retrospective Studies , Treatment Outcome , Ultrasonography, Prenatal
2.
Gynecol Obstet Fertil Senol ; 47(9): 643-649, 2019 09.
Article in French | MEDLINE | ID: mdl-31398445

ABSTRACT

INTRODUCTION: Intra-abdominal calcifications (iAC) detected during fetal ultrasound examinations are characterized by their isolated or associated nature, as well as their location. Our objective was to describe all cases of isolated iAC along with their etiological investigations and neonatal outcome, during a 10-year practice in a referral center. METHODS: We conducted a retrospective descriptive monocentric study on neonates diagnosed with isolated iAC after antenatal expert ultrasound scan and referred to the Multidisciplinary Center for Prenatal Diagnosis at Trousseau Hospital and born between January 1st, 2008 and June 30th, 2018. The exclusion criteria were: retroperitoneal calcifications, iAC associated with other digestive abnormalities or with congenital malformations. RESULTS: The 32 isolated iAC cases accounted for 46% of all iAC. Nine cases were excluded for missing neonatal data. Among the 23 remaining isolated iAC cases, we observed 15 intra-hepatic calcifications, 5 peri-hepatic and two peritoneal calcifications. One fetus had both intra- and peri-hepatic calcifications. The majority of iAC remained stable throughout pregnancy. No cases of aneuploidy, fetal infection, or cystic fibrosis were detected. The neonatal outcome was favorable in all cases. CONCLUSIONS: In case of isolated and stable iAC after expert ultrasound scan, after having ruled out infectious diseases of the fetus and looked for the most frequent mutations of cystic fibrosis in the parents, the prognosis is favorable. Fetal karyotyping is recommended when additional structural anomalies are present.


Subject(s)
Calcinosis/diagnostic imaging , Pregnancy Outcome , Ultrasonography, Prenatal , Aneuploidy , Calcinosis/embryology , Cystic Fibrosis/diagnosis , Cystic Fibrosis/genetics , Female , Fetal Diseases/diagnosis , Humans , Infant, Newborn , Infections/diagnosis , Infections/embryology , Liver Diseases/diagnostic imaging , Liver Diseases/embryology , Peritoneal Diseases/diagnostic imaging , Peritoneal Diseases/embryology , Pregnancy , Retrospective Studies
3.
Arch Pediatr ; 24(5): 464-467, 2017 May.
Article in French | MEDLINE | ID: mdl-28336004

ABSTRACT

Postnatally diagnosed congenital diaphragmatic hernias (CDH) are rare and have a better prognosis than those diagnosed prenatally. Postnatal symptoms can be respiratory, digestive, or mixed. Gastric volvulus can reveal CDH. Symptoms are pain, abdominal distension, and/or vomiting. Upper gastrointestinal barium X-ray radiography provides the diagnosis. Prognosis is related to early surgical management in complicated forms with intestinal occlusion or sub-occlusion. We report on an infant who presented with vomiting, which revealed gastric volvulus associated with a CDH. Progression was favorable after surgical treatment.


Subject(s)
Hernias, Diaphragmatic, Congenital/diagnosis , Stomach Volvulus/diagnosis , Stomach Volvulus/etiology , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Laparoscopy , Male , Pregnancy , Prognosis
4.
J Visc Surg ; 149(4): e262-3, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22704710

ABSTRACT

Obesity has become a major public health concern. More and more patients with substantial obesity require surgery including complex hepatobiliary interventions. The morphology of these patients can make surgery difficult, especially in terms of exposure. We report the case of an obese patient who required a left hemihepatectomy for colorectal liver metastasis. It was very difficult to obtain adequate exposure; this problem was solved by transcutaneous introduction of the handle of a broad costal margin retractor. We describe this maneuver, which allowed us to carry out the intervention under excellent conditions.


Subject(s)
Adenocarcinoma/surgery , Hepatectomy/methods , Liver Neoplasms/surgery , Obesity/complications , Adenocarcinoma/complications , Adenocarcinoma/secondary , Colonic Neoplasms/pathology , Female , Hepatectomy/instrumentation , Humans , Liver Neoplasms/complications , Liver Neoplasms/secondary , Middle Aged
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