Abstract
We report the cases of two children with a congenital very short bowel (18 and 20 cm) which has been surgically lengthened. In both cases, the short jejunum was distended because of a proximal atresia associated with laparoschisis in case n° 1, and in functional obstruction above a jejunocolic anastomosis (case n°2). Lengthening of the jejuna loop was performed following Bianchi's technique of longitudinal partition, modified with immediate end to end isoperistaltic anastomosis. The post operative course was uneventful with a satisfactory radiographic control. Further evolutin was: in case n° 1, under Parenteral Nutrition (PN), progressive oral refeeding from day 40 on, by constant rate enteral nutrition; PN defiitively stopped at 8 months, and totally fractionned feeding at 3½ years. In case n° 2, under PN, oral fractionned feeding onset at day 40, with enteral decontamination; at 8 months PN providing only 1/5 of caloric needs. The growth of both patients is normal. Adaptation of bowel is attested and development of villous hypertrophy in case n° 1. A third child has just had the same surgical procedure at 1 year of age for a very short bowel after a neonatal volvulus. In conclusion, bowel lengthening restores an efficient intestinal peristaltis without reduction of the absorptive surface. This surgical procedure is very useful to promote faster adaptation of very short distended bowels.
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