An alternative management option for colonic atresia preventing loss of the ileocecal valve.
OBJECTIVE
Management of colonic atresia is contentious, with primary anastomosis having a notable risk of anastomotic leak. In addition, resection of the terminal ileum and ileocecal (i-c) valve is frequently performed, risking side effects such as diarrhea, vitamin B(12) deficiency, and gall stone formation.


METHODS
The hospital coding system was searched for all patients with a diagnosis of colonic atresia between July 2005 and July 2008. Four term neonates were managed by formation of an ileostomy, a "blow hole" stoma just proximal to the atresia, and a mucus fistula distal to the atresia.


RESULTS
Average time to full feeds was 7.5 days (range, 3-12 days), and average length of stay was 23 days (range, 13-47 days). Stoma management, problematic in 2 infants, was individualized by a specialist stoma nurse. Ileostomy output was refed into the mucus fistula. Complications included 3 episodes of prolapse of the blow hole stoma in infant 2. All of the infants returned to the operating theater at 1 to 3 months of age for restoration of bowel continuity and closure of the ileostomy. The atretic segment was resected, and an end-to-end anastomosis was performed. Recovery was straightforward in all cases.


CONCLUSIONS
A procedure that retains the i-c valve and most of the colon through creation of a blow hole stoma in the distended proximal colon with a diverting ileostomy and mucus fistula is described. The technique is recommended in selected infants as bowel length and anatomy can be preserved, despite the use of multiple stomas.
Corbett
Harriet J
HJ
Department of Pediatric Surgery, Alder Hey Children's Hospital, Eaton Road, L12 2AP Liverpool, United Kingdom. harrietcorbett@nhs.net
Turnock
Rick R
RR
D003106:Colon / Q000002:abnormalities*; D003672:Defecation / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D007080:Ileocecal Valve / Q000502:physiology*; D007081:Ileostomy / Q000379:methods*; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome