Anastomotic ulcers in short bowel syndrome: New suggestions from a multidisciplinary approach

Fabio Fusaro, Renato Tambucci, Erminia Romeo, Pietro Bagolan, Luigi Dall'Oglio, Stefano Ceccarelli, Paola Francalanci, Dominique Hermans, Andrea Pietrobattista, Antonella Diamanti, Filippo Torroni, Paola De Angelis

Research output: Contribution to journalArticle

Abstract

Background and aims: Anastomotic ulceration (AU) is a rare potential life-threatening complication that may occur after intestinal resection. The diagnosis is often delayed after a long-lasting history of refractory anemia. The pathogenesis remains unknown and there are no established therapies. The aim of the study was to analyze the medical history of children with short bowel syndrome (SBS) who were experiencing AU. Methods: Records of SBS children were retrospectively reviewed. Demographics, baseline characteristics, presentation, diagnosis and treatment of AU cases were analyzed. Results: Eight out of 114 children with SBS were identified as having AU. Mean gestational age was 32.5. weeks. Underlying diseases were: 5 necrotising enterocolitis, 2 gastroschisis and 1 multiple intestinal atresia. The mean age at AU diagnosis was 6.5. years (diagnosis delay of 35. months). All but 2 patients had AU persistency after medical treatment. Endoscopic treatment (2 argon plasma coagulation; 1 platelet-rich fibrin instillation; 2 endoscopic hydrostatic dilations) was effective in 3 out of 5 children. Surgery was required in 3 patients. Conclusions: Severe bowel ischemic injury, especially in preterm infant, could predispose to AU development. Medical treatment showed discouraging results. We firstly described that different endoscopic treatment could be attempted before resorting to further surgery. Level of Evidence: IV.

Original languageEnglish
JournalJournal of Pediatric Surgery
DOIs
Publication statusAccepted/In press - Feb 8 2017

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Short Bowel Syndrome
Ulcer
Therapeutics
Argon Plasma Coagulation
Gastroschisis
Refractory Anemia
Necrotizing Enterocolitis
Fibrin
Premature Infants
Gestational Age
Dilatation
Blood Platelets
History
Demography
Wounds and Injuries

Keywords

  • Anastomotic ulceration
  • Bowel ischemic injury
  • Endoscopic treatment
  • Prematurity
  • Short bowel syndrome

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

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title = "Anastomotic ulcers in short bowel syndrome: New suggestions from a multidisciplinary approach",
abstract = "Background and aims: Anastomotic ulceration (AU) is a rare potential life-threatening complication that may occur after intestinal resection. The diagnosis is often delayed after a long-lasting history of refractory anemia. The pathogenesis remains unknown and there are no established therapies. The aim of the study was to analyze the medical history of children with short bowel syndrome (SBS) who were experiencing AU. Methods: Records of SBS children were retrospectively reviewed. Demographics, baseline characteristics, presentation, diagnosis and treatment of AU cases were analyzed. Results: Eight out of 114 children with SBS were identified as having AU. Mean gestational age was 32.5. weeks. Underlying diseases were: 5 necrotising enterocolitis, 2 gastroschisis and 1 multiple intestinal atresia. The mean age at AU diagnosis was 6.5. years (diagnosis delay of 35. months). All but 2 patients had AU persistency after medical treatment. Endoscopic treatment (2 argon plasma coagulation; 1 platelet-rich fibrin instillation; 2 endoscopic hydrostatic dilations) was effective in 3 out of 5 children. Surgery was required in 3 patients. Conclusions: Severe bowel ischemic injury, especially in preterm infant, could predispose to AU development. Medical treatment showed discouraging results. We firstly described that different endoscopic treatment could be attempted before resorting to further surgery. Level of Evidence: IV.",
keywords = "Anastomotic ulceration, Bowel ischemic injury, Endoscopic treatment, Prematurity, Short bowel syndrome",
author = "Fabio Fusaro and Renato Tambucci and Erminia Romeo and Pietro Bagolan and Luigi Dall'Oglio and Stefano Ceccarelli and Paola Francalanci and Dominique Hermans and Andrea Pietrobattista and Antonella Diamanti and Filippo Torroni and {De Angelis}, Paola",
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doi = "10.1016/j.jpedsurg.2017.05.030",
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T1 - Anastomotic ulcers in short bowel syndrome

T2 - New suggestions from a multidisciplinary approach

AU - Fusaro, Fabio

AU - Tambucci, Renato

AU - Romeo, Erminia

AU - Bagolan, Pietro

AU - Dall'Oglio, Luigi

AU - Ceccarelli, Stefano

AU - Francalanci, Paola

AU - Hermans, Dominique

AU - Pietrobattista, Andrea

AU - Diamanti, Antonella

AU - Torroni, Filippo

AU - De Angelis, Paola

PY - 2017/2/8

Y1 - 2017/2/8

N2 - Background and aims: Anastomotic ulceration (AU) is a rare potential life-threatening complication that may occur after intestinal resection. The diagnosis is often delayed after a long-lasting history of refractory anemia. The pathogenesis remains unknown and there are no established therapies. The aim of the study was to analyze the medical history of children with short bowel syndrome (SBS) who were experiencing AU. Methods: Records of SBS children were retrospectively reviewed. Demographics, baseline characteristics, presentation, diagnosis and treatment of AU cases were analyzed. Results: Eight out of 114 children with SBS were identified as having AU. Mean gestational age was 32.5. weeks. Underlying diseases were: 5 necrotising enterocolitis, 2 gastroschisis and 1 multiple intestinal atresia. The mean age at AU diagnosis was 6.5. years (diagnosis delay of 35. months). All but 2 patients had AU persistency after medical treatment. Endoscopic treatment (2 argon plasma coagulation; 1 platelet-rich fibrin instillation; 2 endoscopic hydrostatic dilations) was effective in 3 out of 5 children. Surgery was required in 3 patients. Conclusions: Severe bowel ischemic injury, especially in preterm infant, could predispose to AU development. Medical treatment showed discouraging results. We firstly described that different endoscopic treatment could be attempted before resorting to further surgery. Level of Evidence: IV.

AB - Background and aims: Anastomotic ulceration (AU) is a rare potential life-threatening complication that may occur after intestinal resection. The diagnosis is often delayed after a long-lasting history of refractory anemia. The pathogenesis remains unknown and there are no established therapies. The aim of the study was to analyze the medical history of children with short bowel syndrome (SBS) who were experiencing AU. Methods: Records of SBS children were retrospectively reviewed. Demographics, baseline characteristics, presentation, diagnosis and treatment of AU cases were analyzed. Results: Eight out of 114 children with SBS were identified as having AU. Mean gestational age was 32.5. weeks. Underlying diseases were: 5 necrotising enterocolitis, 2 gastroschisis and 1 multiple intestinal atresia. The mean age at AU diagnosis was 6.5. years (diagnosis delay of 35. months). All but 2 patients had AU persistency after medical treatment. Endoscopic treatment (2 argon plasma coagulation; 1 platelet-rich fibrin instillation; 2 endoscopic hydrostatic dilations) was effective in 3 out of 5 children. Surgery was required in 3 patients. Conclusions: Severe bowel ischemic injury, especially in preterm infant, could predispose to AU development. Medical treatment showed discouraging results. We firstly described that different endoscopic treatment could be attempted before resorting to further surgery. Level of Evidence: IV.

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