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Article
Gastric Necrosis after Fundoplication: A Novel Approach for Esophageal Preservation
Journal of Pediatric Surgery
  • Kathryn D. Bass
  • David P. Meagher, Jr., Wright State University
  • Gerald M. Haase
Document Type
Article
Publication Date
11-1-1998
Abstract
An 11-year-old boy presented moribund, with massive abdominal distension. A Nissen fundoplication and gastrostomy tube had been established at age 2 years. After attempts to pass a nasogastric tube were unsuccessful, the old gastrostomy site was used to gain percutaneous access to the stomach resulting in release of gastric contents and stabilization of blood pressure and perfusion. During operation, massive gastric distention with gastric necrosis was found. Subtotal gastrectomy was performed with stapled closure of the distal intraabdominal esophagus and prepyloric region. Sump suction was placed in the proximal esophagus and the abdomen was drained widely. A distal esophageal perforation was apparent on postoperative day 19 confirmed by imaging and endoscopy. A nasoesophageal tube was passed into the abdomen, tied to a Jackson-Pratt drain, and the composite tube repositioned in the midesophagus allowing controlled proximal and distal drainage. Six months later, a Hunt-Laurence esophagojejunal pouch was created. At age 13, the child is clinically well, and enjoys 50% of his nutritional needs orally, with the remainder delivered overnight via tube feedings. This case describes gastric necrosis after gas bloat syndrome as a late complication of Nissen fundoplication. A novel approach to the management of distal esophageal perforation allowed preservation of a functional, intact native esophagus.
Comments

This paper was presented at the thirty-first Annual Meeting, Pacific Association of Pediatric Surgeons, Maui, Hawaii, June, 1998

DOI
10.1016/S0022-3468(98)90618-2
Citation Information
Kathryn D. Bass, David P. Meagher and Gerald M. Haase. "Gastric Necrosis after Fundoplication: A Novel Approach for Esophageal Preservation" Journal of Pediatric Surgery Vol. 33 Iss. 11 (1998) p. 1720 - 1722 ISSN: 0022-3468
Available at: http://works.bepress.com/david_meagher/16/