Use of the Hunt-Lawrence pouch in congenital microgastria—a report of 2 cases

doi:10.1016/j.jpedsurg.2010.07.001

Journal of Pediatric Surgery

Volume 45, Issue 11, November 2010, Pages 2238-2240

https://doi.org/10.1016/j.jpedsurg.2010.07.001 Get rights and content

Abstract

Congenital microgastria is an uncommon condition and often associated with other abnormalities. We present 2 patients with congenital microgastria who underwent repair with a Hunt-Lawrence pouch.

Section snippets

Case 1

A 2-day-old, 43-week gestational age male neonate was admitted to our institution for evaluation of abdominal distension. He had no stools in the first 24 hours of life and a barium enema was suspicious for Hirschsprung's disease. A rectal biopsy was performed, which showed the presence of ganglion cells. The patient began stooling but did not tolerate his enteral feedings. An upper gastrointestinal series (UGI) was performed that showed congenital microgastria (<25% of normal size) and

Case 2

A 2-year-old female child was referred to our institution with a diagnosis of congenital microgastria. She was born at 39 weeks via cesarean delivery. Her prenatal ultrasound indicated an absent stomach, no left kidney, and shortened left arm. An UGI study revealed a small midline stomach consistent with microgastria. The patient had been fed via a transpyloric tube that was changed to a surgical jejunostomy tube before discharge. The patient also had limb reduction complex and a patent ductus

Discussion

Microgastria is an uncommon entity. Only 13 children in the literature have been managed with a Hunt-Lawrence pouch, and there is only one report of long-term follow-up [2]. It is commonly associated with asplenia, malrotation, cardiac, renal, skeletal, diaphragmatic [4], and other gastrointestinal anomalies. Initial workup should include identification of other anomalies. Various maneuvers have been used for nutrition and growth before definitive operative intervention. These maneuvers range

References (7)

JonesV.S. et al.
An eighteen year follow-up after surgery for congenital microgastria—case report and review of literature
J Pediatr Surg
(2007)
VelascoA.L. et al.
Management of congenital microgastria
J Pediatr Surg
(1990)
MoultonS.L. et al.
Congenital microgastria in a premature infant
J Pediatr Surg
(1994)

There are more references available in the full text version of this article.

Cited by (12)

Isolated congenital microgastria
2022, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
It results from arrested embryogenesis of the dorsal mesogastrium, so, the greater omentum became poorly formed. This occurs during the fourth and fifth week of fetal development leading to a tubular stomach that has a small reservoir capacity [6,7]. The small reservoir capacity of the stomach leads to the megaesophagus, the incompetent gastroesophageal sphincter, vomiting, averse to feed, malnutrition, aspiration, recurrent respiratory tract infections, and failure to thrive [7,8].
Infants with recurrent vomiting and respiratory tract infection since birth constitute a challenging diagnosis for pediatric surgeons. The surgeon must put in mind a congenital microgastria (CM) as a differential diagnosis.
A five-month-old male infant complained of non-bilious vomiting since birth. A gastrografin swallow had referred to the dilated esophagus, small capacity stomach, and the contrast flows easily distally to the duodenum. A gastric augmentation was created through a Hunt-Lawrence (HL) pouch with a good outcome.
Diagnosis of CM can be discovered during the intrauterine life through the absence of visualization of the gastric gas. CM may be associated with other anomalies or may be isolated. The isolated anomaly should operate early, as soon as possible because the stomach will not spontaneously enlarge with the conservative management.
HL pouch is a suitable gastric augmentation for the infant with isolated CM. The dilated esophagus returns to its normal size after increasing the stomach reservoir.
Congenital Anomalies and Surgical Disorders of the Stomach
2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
Hypertrophic pyloric stenosis presents with projectile vomiting in neonates. After correction of the dehydration and metabolic alkalosis, pyloromyotomy provides permanent relief. Congenital gastric outlet obstructions can be caused by distal gastric webs, atresias, or duplications. Treatment involves excision of the obstruction or surgical bypass maneuvers. Focal foveolar hyperplasia is a rare cause of gastric outlet obstruction. Treatment is surgical or endoscopic. Gastric volvulus is a twisting of the stomach with risk of ischemia and necrosis of the stomach. Immediate surgical correction with detorsion is paramount. Congenital microgastria is characterized by a hypoplastic stomach and megaesophagus. Surgical feeding access may be necessary. Gastric augmentation is the last resort for treatment. Gastric perforation may occur as a result of trauma, hypoxic/ischemic, duodenal or jejunal obstruction, medications, esophageal atresia, or spontaneously. Intestinal duplications can occur anywhere from the mouth to the anus. Accumulation of mucosal secretions can produce a mass effect, leading to obstruction. Presentation is dependent on location and size. Whenever possible, treatment is complete excision. Gastric polyps are uncommon in children. Most polyps can be removed endoscopically. Patients with familial adenomatous polyposis, Peutz-Jeghers syndrome, and juvenile polyposis require lifelong care due to increased risk of malignancy. Gastric tumors of all types are rare and include lymphomas, leiomyomas, leiomyosarcomas, teratomas, carcinomas, gastrointestinal stromal tumors, carcinoid tumors, and inflammatory pseudotumors. Most isolated gastrointestinal tumors are treated by radical complete surgical resection. Foreign body ingestion is a common pediatric problem. In cases of witnessed ingestion or sonographic or radiologic evidence, button batteries, multiple magnets, and sharp objects should be removed immediately. Endoscopy has a high success rate.
Intrauterine left gastric artery infarct as the primary etiology for congenital nonsyndromic microgastria
2019, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
The small gastric capacity leads to a series of symptoms including postprandial vomiting, diarrhea, gastroesophageal reflux and malnutrition. These symptoms lead to nutritional deficiencies and failure to thrive [4–10]. We describe the first case of congenital microgastria caused by a vascular accident in utero with radiological evidence of left gastric artery absence treated with nutrition optimization via a Bishop-Koop type jejunal feeding stoma and subsequent Hunt-Lawrence gastric augmentation.
Congenital Microgastria is a rare condition associated with multiple associated anomalies. We present the first case of a newborn female patient diagnosed with isolated microgastria caused by a vascular accident in utero with absence of the left gastric artery. The patient had a 2 month history of gastroesophageal reflux, postprandial emesis, diarrhea, and failure to thrive. It was sequentially treated with nutritional optimization via a Bishop-Koop type proximal jejunal feeding stoma, and subsequent Hunt-Lawrence gastric augmentation. The patient has recovered from surgery and caught up in terms of weight expectancy for age.
Peptic Ulcer and Other Conditions of the Stomach
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and Print
Peptic Ulcer and Other Conditions of the Stomach
2012, Pediatric Surgery
Gastric dissociation for the treatment of congenital microgastria with paraesophageal hiatal hernia
2011, Journal of Pediatric Surgery
Citation Excerpt :
Neifeld et al [17] were the first to report the use of the Hunt-Lawrence pouch in infants with congenital microgastria. Numerous case reports suggest quite favorable outcomes after Hunt-Lawrence pouch reconstruction for microgastria, although durable, age-appropriate weight gain has rarely been reported [4,6,7,18]. Moreover, adequate control of gastroesophageal reflux remains a concern in these patients.
Microgastria is a rare but well-described congenital anomaly of the alimentary tract that presents in the neonatal period with vomiting, aspiration, and failure to thrive. Based on a relatively small number of case reports, gastric augmentation with a double-barrel loop of jejunum, known as a Hunt-Lawrence pouch, has been advocated as the reconstructive procedure of choice in affected children who fail nonoperative management. In this report, we present a novel method of foregut reconstruction in an infant with congenital microgastria and a paraesophageal hiatal hernia. In this procedure, the stomach was transected 1 cm below the gastroesophageal junction with construction of a straight Roux-en-Y jejunal anastomosis to the gastric fundic cuff. A feeding gastrostomy tube was placed into the distal remnant stomach for enteral access. The patient did well and eventually transitioned to full oral feeds by 3 years of age.

View all citing articles on Scopus

View full text

Case reportUse of the Hunt-Lawrence pouch in congenital microgastria—a report of 2 cases

Abstract

Section snippets

Case 1

Case 2

Discussion

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Case report
Use of the Hunt-Lawrence pouch in congenital microgastria—a report of 2 cases