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Outcome After Surgical Repair of Junctional Epidermolysis Bullosa–Pyloric Atresia Syndrome
A Report of 3 Cases and Review of the Literature
Jan P. Dank, MD;
Susan Kim, MD;
Melissa A. Parisi, MD, PhD;
Tod Brown, PhD;
Lynne T. Smith, PhD;
John Waldhausen, MD;
Virginia P. Sybert, MD
Arch Dermatol. 1999;135:1243-1247.
Background Junctional epidermolysis bullosa–pyloric atresia syndrome is recognized as a distinct autosomal recessive entity. Affected infants present with skin fragility and inability to feed due to intestinal obstruction. Despite successful surgical repair of the anatomical defect, the outcome is poor owing to poor feeding, malabsorption, failure to thrive, and sepsis.
Observations In 70 cases of intestinal obstruction and epidermolysis bullosa reported in the medical literature and the 3 reported here, surgical intervention was attempted 51 times. In all except 16 infants, death occurred before age 11 months (mean age, 70 days). Renal involvement and continued failure to thrive accompanied the skin disease in survivors, who ranged in age from 30 days to 16 years (mean age, 4.0 years).
Conclusions The poor prognosis of this condition must be considered when decisions are made regarding surgical correction. Attempting surgical correction may be warranted in individual circumstances, but withholding surgical intervention and providing palliative support is an acceptable alternative.
From the Divisions of Dermatology (Drs Dank, Kim, Smith, and Sybert) and Medical Genetics (Dr Parisi), Department of Medicine, University of Washington School of Medicine, the Division of Basic Sciences, Fred Hutchinson Cancer Research Center (Dr Brown), and the Department of Surgery, Children's Hospital and Regional Medical Center (Dr Waldhausen), Seattle, Wash.
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