Related Experiment Video
Updated: Aug 13, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Small-bowel plication prevents ileostomy prolapse in young children with inflammatory bowel disease
Peter Mattei1,2
1General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, HUB 2525, 34th Street & Civic Center Blvd., Philadelphia, PA, 19104, USA. mattei@chop.edu.
Insights
A new surgical technique, bowel plication, effectively prevents ileostomy prolapse in children with very early-onset inflammatory bowel disease (VEO-IBD). This simple method reduces complications in high-risk pediatric patients requiring ileostomy.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Very early-onset inflammatory bowel disease (VEO-IBD) in children can necessitate ileostomy diversion or colectomy with ileostomy.
- Ileostomy complications, particularly prolapse, are frequent and challenging in this young population.
- Ileostomy prolapse can cause pain, recurrence, and may require further surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of a novel bowel plication technique in preventing ileostomy prolapse in pediatric VEO-IBD patients.
- To assess the safety and complication rates associated with ileostomy creation or revision using this plication method.
Main Methods:
- Ten consecutive children with VEO-IBD underwent ileostomy creation or revision over six months.
- A running permanent monofilament suture was used to plicate the ileum approximately 3 cm proximal to the ileostomy.
- Two patients later underwent colectomy with ileostomy revision, with plication maintained.
Main Results:
- No instances of ileostomy prolapse were observed in any patient who underwent bowel plication.
- No cases of ileostomy retraction, parastomal hernia, or ostomy-level obstruction occurred.
- One patient experienced a small bowel obstruction due to adhesions, requiring lysis; otherwise, stomas functioned well without complications.
Conclusions:
- Simple bowel plication is a rapid and effective strategy for preventing ileostomy prolapse in pediatric VEO-IBD patients.
- This technique offers a promising solution to reduce the high incidence of ileostomy prolapse in this vulnerable group.
- Bowel plication appears to be a safe and well-tolerated method for managing ileostomies in children with VEO-IBD.
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.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...