Topical intraperitoneal papaverine to minimize non-viable bowel resection from non-occlusive bowel ischemia in neonatal segmental volvulus: A case report

Roger Chen Zhu, Gamal Marey, Vadim Kurbatov, David Kashan, Jason Sulkowski, Gainosuke Sugiyama, Francisca Tolete Velcek

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Arrest in the embryologic intestinal rotation around the superior mesenteric artery prevents proper mesenteric attachment and subjects the gut to volvulus and ischemia which may lead to bowel resection. The length of non-viable resected bowel has been shown by Teitelbaum et al. to be an independent predictor of survival in patients with postoperative short bowel syndrome (RR = 5.74, P = .003). Non-occlusive mesenteric ischemia (NOMI) is a feed-forward loop of vasoconstriction that aggravates the primary ischemic injury. It is an initially reversible process and a potential point of intervention for preservation of viable bowel. The Boley et al. algorithm for management of adult NOMI utilizes intravascular papaverine infusion to increase intracellular cAMP, decreasing calcium concentration and halting vasospasm. We present a modified version of this approach using topical papaverine in the setting of neonatal post-ischemic NOMI, with the goal of minimizing bowel resection.

Original languageEnglish
Pages (from-to)35-37
Number of pages3
JournalJournal of Pediatric Surgery Case Reports
Volume13
DOIs
StatePublished - 1 Oct 2016
Externally publishedYes

Keywords

  • NOMI
  • Non-occlusive mesenteric ischemia
  • Papaverine
  • Short bowel syndrome

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