Application of mushroom type drainage tube in children with terminal ileum perforation: a report of 4 cases

Abstract

Objective To explore the feasibility and safety of applying mushroom type drainage tube fistula in pediatric terminal ileal perforation. Methods From January 1, 2015 to May 31, 2015, we collected the clinical data of mushroom type drainage tube from 4 cases of ileal perforation and retrospective analysis was performed. During emergency laparotomy, terminal ileum perforation was identified. And the distance was 1.5 to 3 cm away from perforation. All patients were boys aged 6-33 months. Results Four cases had a fever of <38 ℃ at Day 1 and 2 post-operation. At Day 3, fever disappeared with anal exhaust, normal defecation and intestinal peristalsis. At Day 4, gastric tube was extracted and a liquid diet was offered. At Day 6, there was a normal diet. Because of relaxation suture, the average length of stay was 2 weeks. During hospitalization, mushroom type drainage tube was connected to a distal drainage bag. A small amount of water was discharged with gas exhaust. All patients were cured and discharged after 2 months. During re-examinations at 2 months, diet, stool and urine were normal. Drainage tube had no obvious fecal discharge. After extraction at 1 week, body surface skin healed. During a follow-up period of 6 months, there was no relevant complication. Conclusions Terminal ileum perforation (around 10 cm away from ileocecus) can not be cured by one-stage anastomosis. The conventional approaches include distal ileum closure, ileum-colon anastomosis; resection of ileocecus, ileum-colon anastomosis, perforation repair and proximal ileum-colon anastomosis. All of the above complications had negative effects on physical and mental developments of children. However, mushroom type drainage tube may avoid resection of ileocecus for ileum perforation. Thus ileostomic complications and adverse outcomes of two-stage surgery are prevented. It is worthy of wider clinical applications. Key words: Ileostomy; Intestinal perforation; Mushroom type drainage tube