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Updated: Feb 28, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Anastomotic ulcers in short bowel syndrome: New suggestions from a multidisciplinary approach
Fabio Fusaro1, Renato Tambucci2, Erminia Romeo1
1Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Anastomotic ulceration (AU) in children with short bowel syndrome (SBS) is often diagnosed late and difficult to treat. Endoscopic interventions show promise before surgery.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Neonatology
Background:
- Anastomotic ulceration (AU) is a rare, potentially fatal complication post-intestinal resection.
- Diagnosis is frequently delayed, often presenting as refractory anemia.
- The exact cause and optimal treatments for AU remain unknown.
Purpose of the Study:
- To analyze the clinical history of pediatric patients with short bowel syndrome (SBS) who developed anastomotic ulceration (AU).
Main Methods:
- Retrospective review of medical records for children with SBS and AU.
- Analysis of demographics, baseline characteristics, presentation, diagnosis, and treatment outcomes.
Main Results:
- Eight of 114 SBS children (mean gestational age 32.5 weeks) were diagnosed with AU.
- Mean age at diagnosis was 6.5 years, with a 35-month delay; common underlying conditions included necrotizing enterocolitis.
- Medical treatment was largely ineffective; endoscopic treatments (argon plasma coagulation, platelet-rich fibrin, dilations) succeeded in 3 of 5 patients, while 3 required surgery.
Conclusions:
- Severe bowel ischemic injury, particularly in preterm infants, may increase AU risk.
- Medical management of AU in SBS patients yielded poor results.
- Endoscopic therapies offer a viable treatment option before considering surgical intervention for AU.
Background And Aims:
Anastomotic ulceration (AU) is a rare potential life-threatening complication that may occur after intestinal resection. The diagnosis is often delayed after a long-lasting history of refractory anemia. The pathogenesis remains unknown and there are no established therapies. The aim of the study was to analyze the medical history of children with short bowel syndrome (SBS) who were experiencing AU.
Methods:
Records of SBS children were retrospectively reviewed. Demographics, baseline characteristics, presentation, diagnosis and treatment of AU cases were analyzed.
Results:
Eight out of 114 children with SBS were identified as having AU. Mean gestational age was 32.5weeks. Underlying diseases were: 5 necrotising enterocolitis, 2 gastroschisis and 1 multiple intestinal atresia. The mean age at AU diagnosis was 6.5years (diagnosis delay of 35months). All but 2 patients had AU persistency after medical treatment. Endoscopic treatment (2 argon plasma coagulation; 1 platelet-rich fibrin instillation; 2 endoscopic hydrostatic dilations) was effective in 3 out of 5 children. Surgery was required in 3 patients.
Conclusions:
Severe bowel ischemic injury, especially in preterm infant, could predispose to AU development. Medical treatment showed discouraging results. We firstly described that different endoscopic treatment could be attempted before resorting to further surgery.
Level Of Evidence:
IV.
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