Urokinase thrombolysis as a rescue treatment for midgut volvulus ischemia

摘要

Midgut volvulus in infants may lead to extreme short bowel syndrome. Strategies to avoid post-ischemia bowel loss have been proposed, involving thrombolysis prior to a definitive surgical treatment. Haemorrhagic risks in these patients may withhold from this approach. Herein we describe the use of urokinase systemic infusion after an unsatisfactory second look laparotomy, performed in a term baby with midgut volvulus. Continuous infusion of urokinase was given for seventeen hours prior to a third laparotomy. A total of 25?cm of small bowel were finally kept in place. Twelve months after the 1st laparotomy the patient was on oral feeding 125?calories/Kg/day. This case showed the possible rescue role of a fibrinolytic agent against persistent ischemia after the second look laparotomy for neonatal volvulus. Highlights ? Urokinase systemic infusion in a neonate with midgut volvulus is presented. ? Savaged bowel showed high adaptation potential. ? Fibrinolytic treatment can be still effective 36?h after the derotation.