2022 Volume 58 Issue 1 Pages 57-61
Maximal preservation of an ischemic but potentially recoverable intestinal tract is attempted during surgery for midgut volvulus to avoid extensive intestinal resection. However, functional disorders of the preserved ischemic intestinal tract might lead to complications in some patients. We report two cases of bowel dysfunction that occurred secondary to ischemia associated with midgut volvulus. [Case 1] A three-day-old male neonate with midgut volvulus was transferred to our hospital and underwent emergency laparotomy. Although we identified an extensive area of ischemic bowel, we resected only the clearly visible necrotic intestine and preserved the ischemic small intestine. The patient developed refractory diarrhea postoperatively, and we suspected nutrient malabsorption in the remaining intestinal tract. [Case 2] A one-day-old male neonate with midgut volvulus was transferred to our hospital and underwent emergency laparotomy. We observed widespread ischemic changes throughout the bowel; however, no necrotic area was detected. We performed a second-look operation the following day, and intraoperatively, the ischemic small intestine appeared to be intact without evidence of progressive necrosis. Therefore, we did not resect any small intestinal segments and preserved the entire bowel. The patient developed frequent postoperative enterocolitis, which suggested intestinal barrier dysfunction of the remaining intestinal tract. Intestinal function was eventually restored in both neonates, and the neonates were weaned off their parenteral nutrition. Clinicians should consider postoperative dysfunction of the ischemic but potentially recoverable intestinal tract that is preserved during a midgut volvulus operation.
