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A mobile cecum predisposing to a major complication of laparoscopic assisted ileostomy

Claudio De Carli1, Juan Bass, Brian Sweeney

  • 1Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|February 14, 2009
PubMed

Insights

Laparoscopic-assisted loop ileostomy (LAI) can lead to cecal volvulus in children, especially those with trisomy 21. Careful evaluation of cecal mobility during LAI is crucial to prevent this serious complication.

Area of Science:

  • Pediatric Surgery
  • Minimally Invasive Surgery
  • Gastrointestinal Surgery

Background:

  • Laparoscopic-assisted stoma creation is increasingly utilized in adult surgery.
  • Previous institutional work has established laparoscopic-assisted colostomy (LAC) in pediatric patients.
  • Laparoscopic-assisted loop ileostomy (LAI) is a specific technique within this domain.

Observation:

  • A case report details a complication in a 4-year-old patient with trisomy 21.
  • The patient underwent a laparoscopic-assisted loop ileostomy (LAI).
  • Postoperatively, the patient developed a volvulus of the cecum around the ileostomy.

Findings:

  • The complication observed was a cecal volvulus secondary to the ileostomy.
  • This suggests a potential risk associated with LAI, particularly in specific patient populations.
  • Cecal mobility and peritoneal attachments appear to be critical factors.

Implications:

  • Careful intraoperative assessment of cecal mobility is recommended during LAI.
  • In cases with inadequate cecal fixation, additional procedures to secure the cecum may be necessary.
  • This approach aims to mitigate the risk of stomal-related cecal volvulus in pediatric surgery.

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