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T-Tube Enterostomy- a Method of Treatment for Intestinal Perforation in Newborns with Low and Extremely Low Weight

Aleksandra Gerasimova, Rumen Hristov, Petar Stamov, Galin Hristov, Sergei Glinkov

Abstract

Introduction: Perforation of the bowel is a complication consisting of different types of intestinal obstruction in childhood and infancy- volvulus, invagination, atresia, meconium ileus, and necrotizing enterocolitis. This condition is life-threatening, requiring urgent surgical intervention, which usually is exteriorization of the bowel and enterostomy. This, on the other hand, is related to prolonged anesthesia and operating time - one of the main disadvantages of this approach. On the other hand, second surgery is needed to recover normal bowel passage.

Materials and Methods: The use of T-tube (Kehrs’ tube) as an approach of temporary decompression of gastrointestinal tract is illustrated with four of the cases of intestinal perforation at the Department of Pediatric Surgery at the St. Anna University Hospital, Varna. In two of them, perforation occurred due to invagination, in one, the reason was spontaneous perforation and in the other - meconium ileus. 

Results: Normal bowel passage was recovered up to the 10th postoperative day and after extraction of the drain the fistula was recovered secondary. The surgical intervention was well tolerated by patients and without associated complications. 

Conclusion: Application of a T-tube drain on the place of perforation solves largely the problems associated exteriorization of the bowel and enterostomy. Such problems are different complications, which can occur during the postoperative period- infection, prolapse, formation of fistula, hemorrhage and others.  It is a sparing and effective method of choice, which is easy to perform technically. The main advantage of the T-tube enterostomy compared to a conventional technique is that a second surgery for recovery of normal passage is not necessary. Additional advantages are the simplicity of extraction of the T-tube and fast closure of the site after that. Our research in Medline database established that this approach is associated with less percentage of complications and mortality in comparison to the convention technique.


Keywords

T-tube enterostomy, intestinal perforation, volvulus, necrotizing enterocolitis


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