Small-bowel plication prevents ileostomy prolapse in young children with inflammatory bowel disease
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In brief
In brief
This case series demonstrates that prophylactic small-bowel plication during ileostomy creation effectively prevents prolapse in young children with very early-onset IBD. Eight consecutive patients underwent the technique with no subsequent prolapse, retraction, or hernia complications, suggesting a simple surgical modification for this high-risk population.
Written by the GCMD Library team from the article.
Abstract
Purpose
Young children with medically refractory very early-onset inflammatory bowel disease (VEO-IBD) sometimes benefit from ileostomy diversion alone or may be offered subtotal colectomy with ileostomy. Though generally well-tolerated, ileostomy complications are frequent. Prolapse is particularly frustrating as it can be difficult and painful to reduce, becomes a recurring problem is some patients, and often requires ostomy revision or bowel resection.
Methods
Over the course of the past 6 months, eight consecutive children with VEO-IBD underwent 10 creation or revision of a diverting ileostomy (two underwent subsequent colectomy with ileostomy revision). In each of these 10 cases, we plicated the ileum just proximal to the ileostomy for a distance of approximately 3 cm using a running permanent monofilament suture.
Results
No patient who underwent plication of bowel has developed ileostomy prolapse. There were no cases of ileostomy retraction, parastomal hernia or ostomy-level obstruction. One patient required a lysis of a single band adhesion for a more proximal small bowel obstruction. The stomas have functioned well and there have been no complications.
Conclusion
Simple bowel plication appears to be a quick and effective way to prevent ileostomy prolapse in young children with VEO-IBD with an ileostomy who are at high risk for prolapse.