The IX t h Makassed Medical Congress - American University of Beirut

T h e I X t h M a k a s e d M e d i c a l C o n g r e s s
ESOPHAGEAL AND GASTRIC LESIONS IN NEONATES
NAHIDA RIFAI, MD
The occurrence of severe lesions in the upper gastrointestinal tract in the neonatal period is
relatively frequent. Upper gastrointestinal bleeding from mucosal lesions has been seen in 6 – 12
% of children in intensive care.
The precise etiology of such lesions is poorly substantiated. Any stressful event during pregnancy
or labor or soon after birth may be inducive of mucosal lesions. Bleeding from the upper
gastrointestinal tract can occur in the setting of hypotension, respiratory insufficiency, renal
failure, sepsis, and in the presence of fetal distress. Antacids and anti-ulcer medications taken
during pregnancy may play a role. Perinatal indomethacin exposure constitutes another
additional risk factor.
The technical improvement in pediatric gastrointestinal endoscopy allowed the evaluation of
esophageal and/or gastric lesions in neonates even in very low birth weight infants. The key of
prevention and treatment of stress-induced gastric lesions is the optimal intensive care. Breast
feeding may play a protective role against severe lesions in neonates. Some of them may benefit
from ulcer prophylaxis.
CONGENITAL SHORT BOWEL SYNDROME: REPORT OF THREE CASES
*Raphah Borghol MD, ‡Dany Hamod MD, §Reva Matta MD,
†Pierre Mouawad MD, *Nabil Diab MD, ‡Elie Aramouni MD
Congenital short bowel syndrome (CSBS) is a rare entity compared to the acquired form.
We present three cases of CSBS manifested in the neonatal period by complicated severe
necrotizing enterocolitis (NEC), and pseudoobstruction. The diagnosis was suspected by barium
intestinal series swallow, and confirmed by surgical laparotomy. The management consists of
total parenteral nutrition (TPN), with one still living case and two fatal outcomes secondary to
septicemia from the central catheter line, and multiorgan failure. In the literature, we note
rare reported cases of such short congenital small bowel length. Normally the small bowel in
neonates measures around 240 cm, in our cases the length were 30 cm, 58 cm, and 75 cm.
The factors in the pathogenesis in these cases are mostly related to antenatal ischemic events,
such as intrauterine volvulus, in utero infarction of bowel, defective neuroenteric system, and
mechanical etiology such as delayed return of fetal gut into the abdomen due to gastroschisis.
The management and prognosis depends mostly on the length of the small bowel and other
factors related to the age of the patient, and their general status.
*Pediatric resident (PGY-I), University Of Balamand, St Georges University Hospital
‡Pediatric Neonatology, St Georges University Hospital
§Pediatric Surgery resident (PGY-III), University Of Balamand, Saint Georges University Hospital
†Pediatric Gastroenterology, Hepatology and Nutrition Unit, St Georges University Hospital
*Pediatric Surgery, St Georges University Hospital
‡Pediatric Gastroenterology, Chief of Departement, St Georges University Hospital.
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