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Gastrointestinal bleeding due to delayed perianastomotic ulceration in children
S A Bhargava1, P E Putnam, S A Kocoshis
1Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, USA.
Insights
Delayed perianastomotic ulcers, a rare surgical complication, can cause severe iron deficiency anemia. Early diagnosis through retrograde ileoscopy is crucial for managing these ulcers after intestinal surgery.
Area of Science:
- Gastroenterology
- Surgical Complications
- Pediatric Surgery
Background:
- Delayed perianastomotic ulcers are an infrequent yet significant complication following intestinal surgery.
- These ulcers can lead to substantial gastrointestinal bleeding and iron deficiency anemia.
Observation:
- Two pediatric cases are presented: one with an ileocolonic anastomotic ulcer at 16 years post-necrotizing enterocolitis surgery, and another with ileoileal anastomotic ulcers at 14 years post-strangulated internal hernia repair.
- These cases highlight the diagnostic challenges associated with delayed anastomotic ulcers.
Findings:
- The study adds two new cases to the fifteen previously reported delayed anastomotic ulcers in the literature.
- Iron deficiency anemia was a prominent symptom in both reported patients.
Implications:
- Diagnosis can be difficult, underscoring the importance of considering delayed perianastomotic ulcers in patients with unexplained anemia after intestinal surgery.
- Retrograde ileoscopy is emphasized as a key diagnostic tool for identifying these ulcers.
Abstract:
Delayed perianastomotic ulcers are a poorly recognized complication of intestinal surgery. We report two patients with this complication of their remote intestinal surgery who developed significant iron deficiency anemia. Patient 1 had intestinal resection for perforated necrotizing enterocolitis as a newborn and presented at 16 yr of age with an ulcer at the ileocolonic anastomosis. Patient 2 had intestinal resection for strangulated internal hernia at 9 yr and was diagnosed with two ulcers at the ileoileal anastomosis at 14 yr of age. Fifteen patients with delayed anastomotic ulcers have so far been reported in the literature. We add two more cases and also emphasize the difficulty in establishing the diagnosis and importance of performing a retrograde ileoscopy.