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Anastomotic ulceration: a late complication of ileocolonic anastomosis

J M Sondheimer1, R J Sokol, M R Narkewicz

  • 1Department of Pediatrics, University of Colorado Health Sciences Center, Children's Hospital, Denver, USA.

The Journal of Pediatrics
|August 1, 1995
PubMed

Insights

Children who underwent neonatal surgery for necrotizing enterocolitis may develop long-term symptomatic ulceration at the ileocolonic anastomosis site. This complication appears inflammatory but is unresponsive to common treatments, suggesting a unique etiology.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Complications

Background:

  • Necrotizing enterocolitis in neonates often necessitates resection of the terminal ileum, ileocecal valve, and proximal colon.
  • Ileocolonic anastomosis is performed following such resections.

Purpose of the Study:

  • To describe a series of children who developed symptomatic ulceration at a previous ileocolonic anastomosis.
  • To investigate the characteristics and potential causes of these ulcers.
  • To review the literature for similar cases.

Main Methods:

  • Case series of six children with symptomatic ulceration at ileocolonic anastomosis.
  • Clinical presentation, histological findings, and treatment responses were documented.
  • Literature review of similar reported cases.

Main Results:

  • Symptomatic ulceration occurred approximately 5.5 years after initial surgery.
  • Symptoms included rectal bleeding, pain, and diarrhea.
  • Ulcers showed inflammatory characteristics but were unresponsive to anti-inflammatory, antibiotic, and immunosuppressive medications.
  • Surgical revision led to rapid recurrence in most cases.
  • Thirteen similar cases were identified in the literature.

Conclusions:

  • Ulceration at the ileocolonic anastomosis is a potential long-term complication following neonatal resection for necrotizing enterocolitis.
  • The etiology of these ulcers remains unknown.
  • Current medical and surgical treatments have limited efficacy.

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