One-step management of apple-peel atresia

Novel Loss of Function Variants in CENPF Including a Large Intragenic Deletion in Patients with Strømme Syndrome

Strømme syndrome is an ultra-rare primary ciliopathy with clinical variability. The syndrome is caused by bi-allelic variants in CENPF, a protein with key roles in both chromosomal segregation and ciliogenesis. We report three unrelated patients with Strømme syndrome and, using high-throughput sequencing approaches, we identified novel pathogenic variants in CENPF, including one structural variant, giving a genetic diagnosis to the patients. Patient 1 was a premature baby who died at 26 days with congenital malformations affecting many organs including the brain, eyes, and intestine. She was homozygous for a donor splice variant in CENPF, NM_016343.3:c.1068+1G>A, causing skipping of exon 7, resulting in a frameshift. Patient 2 was a female with intestinal atresia, microcephaly, and a Peters anomaly. She had normal developmental milestones at the age of 7 years. She is compound heterozygous for CENPF NM_016343.3:c.5920dup and c.8991del, both frameshift. Patient 3 was a male with anomalies of the brain, eye, intestine, and kidneys. He was compound heterozygous for CENPF p.(Glu298Ter), and a 5323 bp deletion covering exon 1. CENPF exon 1 is flanked by repetitive sequences that may represent a site of a recurrent structural variation, which should be a focus in patients with Strømme syndrome of unknown etiology.

T-tube enterostomy in the management of apple-peel atresia: A case series from a single center

BACKGROUND AND OBJECTIVE

Although complex atresias, such as apple-peel and multiple atresias, comprise a smaller percentage, they are usually associated with a higher incidence of postoperative complications and mortality rate. Contrary to simple atresias where the surgical technique of choice usually entails bowel resection and anastomosis with or without enteroplasty, managing apple-peel atresia remains more sophisticated. Decompressive and functionalizing stomas are sometimes mandatory to overcome problems such as increased wall thickness and the wide disparity among the anastomotic ends. Few reports discussed using tube enterostomy in the management of apple-peel atresia; nonetheless, no previous prospective studies were conducted to discuss its efficacy on a larger population. In this study, we are describing our experience using this technique on 12 patients suffering from apple-peel atresia in our center.

METHODS

A prospective study was conducted from June 2015 to May 2020, where all children who were found to have apple-peel atresia were included in the study. T-tube was placed through an enterotomy through the dilated proximal bowel, around 10 cm before the anastomotic line, and was kept in place using a double suture (Stamm technique) before closing the anterior face of the anastomosis. The short distal limb of the T-tube was oriented toward the anastomotic line, while the long proximal limb was directed proximally. After finishing the anastomosis, the T-tube was delivered outside the abdominal wall, anchoring the enterostomy along with the proximal dilated jejunum against the anterior abdominal wall.

RESULTS

A total of 12 cases were encountered throughout the period of study. The mean age at operation was 4 days and the mean birth weight was 2700 g. The mean time for starting oral feeding postoperatively and T-tube removal was 8 and 10.5 days, respectively. Cases were discharged after a mean of 22 days. As regards morbidity and mortality, a single case developed skin excoriations at the site of tube insertion and was managed conservatively using topical ointments and another case died from overwhelming sepsis 3 days after the operation.

CONCLUSION

T-tube enteroplasty is a safe and feasible option in the surgical management of apple-peel atresia. The main strength of our study is its prospective nature and that it includes apple-peel atresia cases only. However, the main limitation is that a larger sample is needed.

Jejuno-ileal atresia: its characteristics and peculiarities concerning apple peel atresia, focused on its treatment and outcomes as experienced in one of the leading South African academic centres

PURPOSE

Jejuno-ileal atresia remains the most common form of intestinal obstruction in the neonatal and infantile age group and has an incidence of 1:300 to 1:1500. Apple peel atresia (APA) is the rarest of the five described types. The morbidity and mortality of patients with APA managed at our institution are high, and we review our experience with this paper. We compared our outcomes with other developed and developing countries. In addition, we looked at factors that affect outcome and how we can change them.

METHODS

The study was a retrospective review of all patients treated with APA at IALCH between January 2002 and December 2010 and includes 34 patients.

RESULTS

The results revealed a mortality in excess of 70%. There were poor antenatal screening, a high rate of prematurity and often delays in transfer to our institution. Relaparotomy and sepsis rates were high.

CONCLUSION

This review represents a significant number of patients with APA from a single institution. Although survival rates have improved significantly over the years, APA remains a life-threatening malformation and results in significant morbidity and mortality in our setting.

Bowel plication in neonatal high jejunal atresia

This study aimed to evaluate the efficacy of bowel plication as a part of the surgical treatment in neonatal high jejunal atresia.Between January 2013 and December 2016, 43 neonates with high jejunal atresia underwent surgical treatment at the Children's Hospital of Fudan University. According to the surgical procedures the patients underwent, the neonates were divided into a bowel plication group and a nonplication group. Eighteen neonates underwent proximal bowel plication after atretic segment resection and primary anastomosis. The other 25 neonates were in the nonplication group and underwent enteroplasty after atretic segment resection. Data were retrospectively analyzed, including gestational age, birth weight, concomitant diseases, age at surgery, duration of operation, length of total parenteral nutrition (TPN), postoperative intestinal function recovery (i.e., the time of the 1st oral feeding and when the oral feeding volume reached 40 mL/kg/3 h), length of hospital stay, growth and development, complications, and reoperations.No differences in gestational age, birth weight, concomitant disease, age at surgery, or duration of operation were found between the 2 groups. The time of the 1st oral feeding, the time when oral feeding volume reached 40 mL/kg/3 h, and duration of TPN for the bowel plication group were shorter than those for the nonplication group (9.4 ± 3.1, 14.6 ± 2.3, 9.2 ± 2.7 days, respectively, vs 13.5 ± 2.6, 17.6 ± 2.8, 14.3 ± 2.4 days, respectively, P < .05). The length of the hospital stay for the bowel plication group was significantly shorter than for the nonplication group (15.3 ± 3.1 days vs 18.5 ± 3.6 days, respectively, P < .05). In the bowel plication group, 1 patient (5.6%) underwent reoperation for intestinal stenosis resulting from neonatal necrotizing enterocolitis 1 year after the initial surgery. However, in the nonplication group, 5 patients (20%) underwent reoperation, including 3 for anastomotic stenosis and 2 for adhesive intestinal obstruction. Follow-up visits occurred for an average period of 2.8 years (6 months to 4.5 years). All infants thrived, and no differences in growth and development were found between the 2 groups.Bowel plication after atretic segment resection and primary anastomosis improves the clinical outcome for neonates with high jejunal atresia.