General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, HUB 2525, 34th Street & Civic Center Blvd., Philadelphia, PA, 19104, USA.
Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Surg Int. 2023 Jan 24;39(1):88. doi: 10.1007/s00383-023-05375-4.
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.
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.
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.
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.
对于某些患有药物难治性极早发性炎症性肠病（VEO-IBD）的幼儿，单纯进行回肠造口术转流可能有益，或者可选择进行次全结肠切除术+回肠造口术。尽管造口术总体上耐受良好，但仍会发生频繁的造口并发症。造口脱垂尤其令人沮丧，因为它可能难以复位且痛苦，在一些患者中会成为复发性问题，并且通常需要进行造口修改或肠切除术。
在过去的 6 个月中，8 例连续的 VEO-IBD 患儿进行了 10 次回肠造口术的创建或修改（其中 2 例随后进行了带有回肠造口术修改的结肠切除术）。在这 10 例中的每一例中，我们在距回肠造口约 3cm 处使用连续永久性单丝缝线对肠管进行折叠，折叠长度约为 3cm。
接受肠管折叠的患者均未发生造口脱垂。没有发生造口回缩、侧方疝或造口水平梗阻的病例。有 1 例患者因近端小肠梗阻需要松解单个粘连带。造口功能良好，无并发症。
在 VEO-IBD 伴回肠造口且造口脱垂风险高的幼儿中，简单的肠管折叠似乎是一种快速有效的预防回肠造口脱垂的方法。
