Beware of stapled side-to-side bowel anastomoses in small children.
Side-to-side, functional end-to-end stapled anastomosis (SS-EESA) is a frequently employed technique to re-establish continuity following bowel resection. We describe, for the first time in children, two cases of an important complication of this form of bowel anastomosis. Patient 1 had resection of a jejunal lymphangioma and formation of an SS-EESA at the age of 3 years. By the age of 7 years he was demonstrating symptoms consistent with malabsorption, which was confirmed by hydrogen breath testing. An upper GI contrast study indicated a segmental dilatation of the distal small bowel. Elective laparotomy revealed partial volvulus of a greatly dilated SS-EESA. Patient 2 had undergone bowel resection as a neonate for ileal atresia, with end-to-end anastomosis. An anastomotic stricture developed at two months of age that was resected with formation of an SS-EESA. Multiple ensuing episodes of partial small bowel obstruction were managed non-operatively until, at 5 years of age, she presented with complete bowel obstruction. At operation, volvulus of a hugely dilated SS-EESA was found. Intraoperative cultures of the succus entericus were consistent with bacterial overgrowth. Both patients were successfully treated with resection of the SS-EESA and primary anastomosis. SS-EESA can be complicated by bacterial overgrowth, massive dilatation and volvulus. In patients with SS-EESA who present with recurrent obstructive symptoms, this complication should be considered.
Jackson
C-C A
CC
Department of General Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada.
Bettolli
M M
MM
De Carli
C F
CF
Bass
J
J
Rubin
S Z
SZ
Sweeney
B
B
D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000002:abnormalities*; D007409:Intestinal Atresia / Q000601:surgery*; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D007580:Jejunal Neoplasms / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D008202:Lymphangioma / Q000601:surgery*; D008297:Male; D011860:Radiography, Abdominal; D012086:Reoperation; D013536:Suture Techniques / Q000009:adverse effects* / Q000295:instrumentation; D013537:Sutures; D013997:Time Factors