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A staged surgical approach to save ischemic bowel
T Palmieri1, K Kimura, R T Soper
1Department of Surgery, University of Iowa College of Medicine, Iowa City.
Journal of Pediatric Surgery
|June 1, 1993
Summary
A novel surgical approach successfully salvaged 80% of a patient's small intestine after strangulation. This method preserves bowel length by avoiding immediate resection of ischemic segments, offering a viable alternative for selected cases.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Innovation
- Pediatric Surgery
Background:
- Small intestinal strangulation poses a significant risk of bowel loss due to ischemia.
- Conventional management often involves resection of compromised bowel segments, potentially leading to short bowel syndrome.
- Omental sling-induced bowel strangulation is a rare but critical surgical emergency.
Observation:
- A 15-year-old female presented with 80% small bowel strangulation by an omental sling.
- Initial assessment revealed only 100 cm of viable proximal jejunum; the remainder appeared necrotic.
- A temporary double-barreled jejunostomy was created at the transition zone, with a planned 'second look' operation.
Findings:
- The 'second look' operation demonstrated partial recovery of blood flow in the exteriorized, seminecrotic bowel segment.
- No bowel resection was performed initially, maximizing potential bowel salvage.
- Subsequent staged reconstruction, including a Bishop-Koop jejunostomy and eventual end-to-end anastomosis, preserved approximately 80% of the small intestine.
Implications:
- This case highlights a successful organ-sparing strategy for managing extensive small bowel ischemia.
- The described approach offers an alternative to immediate resection, potentially improving outcomes for patients with reversible ischemic bowel.
- Maximal salvage of small bowel length is achievable in selected cases of severe ischemic compromise.