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Staple line ulcers: A cause of chronic GI bleeding following STEP procedure

  • Troy E. Gibbons
    Correspondence
    Corresponding author. Department of Pediatrics Gastroenterology, Hepatology and Nutrition, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, 1 Children's Way, Slot # 512-07, 72202. Tel.: +1 501 364 4299; fax: +1 501 364 6291.
    Affiliations
    Gastroenterology, Hepatology and Nutrition, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock AR, USA
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  • Helen B. Casteel
    Affiliations
    Pediatric Gastroenterology, Arkansas Children’s Hospital, Little Rock, AR, USA
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  • Juliana F. Vaughan
    Affiliations
    Gastroenterology, Hepatology and Nutrition, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock AR, USA
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  • Melvin S. Dassinger
    Affiliations
    Surgery Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
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      Abstract

      Intestinal failure (IF) results from a critical reduction in the functional intestinal mass resulting in dependence on total parenteral nutrition (TPN) for growth and survival. Short bowel syndrome (SBS) is the most common cause of intestinal failure in pediatrics. Following resection, the small bowel undergoes adaptation, a process wherein the bowel elongates and dilates in order to increase intestinal absorptive capacity. Small bowel dilatation can lead to dysmotility and small bowel bacterial overgrowth which may further enhance feeding intolerance. Bowel lengthening procedures are beneficial when there is significant dilatation of the small bowel and subsequent inability to advance enteral feeds. We describe a patient with intestine failure and short bowel syndrome due to gastroschisis who, presented with anemia and occult gastrointestinal bleeding, following Serial Transverse Enteroplasty procedure (STEP). Video capsule endoscopy (VCE) revealed multiple ulcerations at surgical staple sites throughout the distal 2/3 of the remaining small intestine which were the likely source of intestinal blood loss.

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