Abstract

Aim: We aimed to evaluate the operative findings, and follow-up of a patient who had partial ileal necrosis due to brid ileus,who had ileo-ileal anastamoses 5 cm proximal to ceacum.

Case report: A 1.5 year old boy was admitted to the pediatric emergency department of our hospital with abdominal pain and vomiting. The image of flat soft tissue mass at abdominal midline on standing direct radiograms was observed. During the abdominal examination, a palpable painful mass sense was present. In exploration, an adhesion band involving approximately 60 cm of the terminal ileum and squeezing the mesentery vessels was seen, and excised. As the lukewarm water compress for 5-10 minutes did not reverse the ischemia, we decided to resect, and remove gangrenous ileal segments. Considering the current toxic condition, a temporary double-barrel ileostomy was made using the distal loop at a 5 cm proximal to terminal ileum and proximal viable ileal segment. The preoperative body weight of the case decreased for 14 kg due to the intensive loss of fluid from the stoma, despite medical support from the pediatric gastroenterology department, after 14 days to 11.5 kg. Then closure of the stoma was decided on the 16th postoperative day In order to preserve ileocecal valve end- toend anastomosis was performed, 5 cm proximal to terminal ileum. Stool frequency decreased, and its content became denser, and at the 12^th postoperative day patient was discharged without any problems. During the control visit in the 1^st month following hospital discharge the clinical findings of the case were normal and the patient weighed 14.5 kg.

Conclusions: In cases well prepared before the operation and intervened with the most appropriate surgical technique and appropriate surgical materials , we consider that anastomosis close to the terminal ileum will not lead to any problems clinically. We believe that anastomosis preserving ileocecal valve will increase the quality of life especially in children with longer life expectancy. However larger series are necessary to verify the findings of the present study.