477 Surgical Solutions and Problems in An Adult Patient with VACTERL Association

Abstract Background We report an adult patient with features of VACTERL - oesophageal and anal atresia, cardiac malformation. In infancy he underwent colonic interposition for atresia using the transverse colon as a conduit. As teenager formation Koch continent ileostomy after previous stoma atresia. Eventual failure pouch nipple valve necessitated laparotomy attempted refashioning. Unfortunately, this operation was beset by life-threatening complications protracted post-operative course. He presented to our hospital laparostomy, high output enterocutaneous fistulae (ECF) necessitating home total parenteral nutrition (TPN), severe cachexia deconditioning. Method Conservative therapy utilised improve nutritional physiological status patient. Simultaneously, attempts were made define anatomy his abdomen in relation surgery. However, notes original procedures (oesophageal reconstruction formation) lost due closure which attended at time. A subsequently performed manage ECFs. Most small intestine unsalvageable multiple adhesions, leaving 35cm bowel terminating end ileostomy. cholecystectomy mitigate gallstone formation. Conclusions Efficient communication is imperative management complex patients. The loss interpretation subsequent imaging planning surgery troublesome. contrast, efficient between teams involved peri-operative care, particularly respiratory intensive care facilitated smooth course successful discharge from hospital.