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Published on: April 17, 2020
Z-shaped anastomosis for the treatment of a benign rectosigmoid stricture
Akira Furuichi1, Yasuharu Ohno, Takayuki Hamada
1Department of Surgery II, Nagasaki University School of Medicine, Nagasaki, Japan.
Insights
A Ladd's operation and adhesiotomy led to sepsis and disseminated intravascular coagulation (DIC) in an infant. A Z-shaped anastomosis effectively treated the resulting rectosigmoid stricture, offering a new approach for similar conditions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Intestinal malrotation and adhesions are common surgical challenges in infants.
- Sepsis and disseminated intravascular coagulation (DIC) can lead to severe complications, including ischemic strictures.
- Rectosigmoid strictures pose significant risks for intestinal obstruction in neonates.
Observation:
- A neonate with malrotation underwent Ladd's operation and adhesiotomy, subsequently developing sepsis and DIC.
- DIC-associated ischemia resulted in a rectosigmoid stricture, necessitating an ileostomy.
- Surgical reconstruction using a Z-shaped anastomosis was performed for the rectosigmoid stricture.
Findings:
- The Z-shaped anastomosis successfully reconstructed the rectosigmoid region after ischemic stricture.
- This technique proved effective in managing a complex case of post-DIC rectosigmoid stricture.
- The patient experienced a favorable outcome following the Z-shaped anastomosis procedure.
Implications:
- Z-shaped anastomosis is a viable and effective treatment for benign rectosigmoid strictures, particularly those arising from ischemia.
- This surgical technique may offer an alternative to traditional methods for managing complex pediatric colorectal conditions.
- Further research into Z-shaped anastomosis for various types of rectosigmoid strictures is warranted.
Abstract:
A girl with malrotation underwent a Ladd's operation at 35 days of age and later had an adhesiotomy at 115 days of age. After the adhesiotomy, she suffered from sepsis and subsequent disseminated intravascular coagulation (DIC). At 178 days of age, she developed an intestinal obstruction because of a rectosigmoid stricture probably caused by DIC-associated ischemia. As a result, an ileostomy was performed. At one year, 4 months of age, she underwent a resection of the proximal part of the rectosigmoid stricture and a reconstruction by means of a Z-shaped anastomosis. Based on our experience, Z-shaped anastomosis appears to be an excellent treatment not only for Hirschsprung's disease but also for benign rectosigmoid stricture.
