ABSTRACT
PURPOSE: Our experience en treatment of gastroschisis using a protocol with elective preterm delivery by caesarean section at 34-35 weeks and immediate primary abdominal wall closure. METHODS: During a period of 18 month we treated 5 patients with gastroschisis using the following management pathway: Starting at 30th week of gestation, weekly ultrasound evaluation of fetal gut and pulmonary maturation with corticosteroids. Delivery by elective caesarean section between 34-35 weeks or earlier if evidence of bowel compromise was reported en ultrasound study. Immediate surgical correction after birth with primary closure was preformed under control of abdominal pressure. RESULTS: Mean gestational age of our patient was 33,94 weeks, and mean birth weight was 2154 gr. None of the cases present inflammatory peel and we found no difficulties for reduction of the gut at time of surgery. Two patients presented an intestinal malrotation. Extubation was preformed 36-48 hours after surgery. We started a trofic diet at 3,6 days and parental nutrition was retired after a mean period of 15,8 days. The mean time of hospital stay was 33,4 days. One patient with intestinal obstruction had a consideriously increased length of hospital stay of 74 days. CONCLUSIONS: A management pathway for gastroschisis with selective preterm delivery by caesarean section and immediate surgical treatment probably reduces the experience of inflammatory peel. This pathway permits a early initiation of oral feeding, reduces times of parenteral nutrition and need of central catheters, and shortens length of hospital stay.
Subject(s)
Cesarean Section , Gastroschisis/surgery , Infant, Premature, Diseases/surgery , Elective Surgical Procedures , Female , Humans , Infant, Newborn , Infant, Premature , Male , Time FactorsABSTRACT
Objetivos. Presentar nuestra experiencia de 5 casos de gastrosquisis con un protocolo de parto por cesárea electiva entre las 34-35 semanas de gestación y cierre primario inmediato en una nota clínica. Material y métodos. En un periodo de 18 meses se han tratado 5pacientes con gastrosquisis con el siguiente protocolo: monitorización ecográfica semanal a partir de los 30 semanas y maduración pulmonar fetal; cesárea electiva entre las 34 y 35 semanas o ante la presencia de signos ecográficos de sufrimiento intestinal; corrección quirúrgica inmediata postparto con cierre primario de la pared bajo control de la presión abdominal. Resultados. La edad gestacional media de los pacientes ha sido de33,94 semanas, el peso medio fue de 2.154 g. No observamos engrosamiento de las asas (peel) en ninguno de los casos y no objetivamos dificultad para la reducción de las asas en la cavidad abdominal. Dos pacientes presentaron una mal rotación intestinal asociada. Se logró la extubación entre las 36 y 48 horas. Instauramos una dieta trófica a los3,6 días de media. La retirada de la nutrición parenteral fue posible a los15,8 días de media y el alta hospitalaria, a los 33,4 días de media. Un caso de oclusión intestinal pre-alta alargó considerablemente la estancia hospitalaria de este paciente (74 días).Conclusiones. Nuestra experiencia apoya el manejo terapéutico de las gastrosquisis mediante cesárea electiva pretérmino y tratamiento quirúrgico inmediato, probablemente sirve para evitar la aparición del temido peel. Este protocolo permite iniciar una dieta oral precozmente ,reduce el tiempo de nutrición parenteral, la necesidad de vías centrales con el riesgo de sepsis y acorta la estancia hospitalaria (AU)
Purpose. Our experience en treatment of gastroschisis using a protocol with elective preterm delivery by caesarean section at 34-35 weeks and immediate primary abdominal wall closure. Methods. During a period of 18 month we treated 5 patients with gastroschisis using the following management pathway: Starting at 30thweek of gestation, weekly ultrasound evaluation of fetal gut and pulmonary maturation with corticosteroids. Delivery by elective caesarean section between 34-35 weeks or earlier if evidence of bowel compromise was reported en ultrasound study. Immediate surgical correction afterbirth with primary closure was preformed under control of abdominal pressure. Results. Mean gestational age of our patient was 33,94 weeks, and mean birth weight was 2154 gr. None of the cases present inflamatory peel and we found no difficulties for reduction of the gut at time of surgery. Two patients presented an intestinal malrotation. Extubation was preformed 36-48 hours after surgery. We started atrophic diet at 3,6 days and parental nutrition was retired after a mean period of 15,8 days. The mean time of hospital stay was 33,4 days. One patient with intestinal obstruction had a consideriously increased length of hospital stay of 74 days. Conclusions. A management pathway for gastroschisis with selective preterm delivery by caesarean section and immediate surgical treatment probably reduces the experience of infl ammatory peel. This pathway permits a early initiation of oral feeding, reduces times of parenteral nutrition and need of central catheters, and shortens lengthof hospital stay (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Gastroschisis/surgery , Abdominal Wound Closure Techniques , Prenatal Diagnosis/methods , Abdominal Wall/surgery , Clinical ProtocolsABSTRACT
We describe three severe clinic cases due to fungus balls of Candida albicans in hospitalized risky patients which presented a quickly clinical evolution. Because of their different local presentations medical and surgical management was needed. In the first case a intestinal fungus ball was found whereas in the other two cases were localized in the urinary tract. Here we present their clinical findings rather than their evolution after a medical and surgical management.
