Distal ileal necrosis: Right ileo-colic intussuscepted anastomosis as an alternative to ileostomy

Abstract

The technique of ileo-right colic intussuscepted anastomosis creating a neo-ileo-colic valve, was first described by Ribault in 1989 and has been shown to be of value in patients with typhoid ileal perforation as well as in other non-cancerous lesions of the terminal ileum. This technique is simple and rapid, and avoids ileostomy and/or ileo-cecal resection. The goal of this case-series was to describe the technique of ileo-right colic intussuscepted anastomosis as an alternative to ileostomy. This is a retrospective, monocenter study of patients with lesions of the terminal ileum who were managed with right ileo-colic intussuscepted anastomosis between January 2008 and December 2013. The technique was standardized. The main outcome criterion was the post-operative complication rate. Four patients, three female and one male, with a median age of 35 years were managed with ileo-right colic intussuscepted anastomosis for necrosis of the terminal ileum. The cause of distal ileal necrosis was necrosis secondary to tubo-ovarian abscess and perforation secondary to non-specific ileitis, in one patient each, and band-related bowel obstruction with extended necrosis in two patients. There was no reported post-operative morbidity or mortality and, in particular, no post-operative anastomotic leak occurred. Based on the findings in the literature and our series, right ileo-colic intussuscepted anastomosis is a simple technique, easy to learn and associated with little morbidity. These advantages underscore the need to be aware of this technique, which is particularly useful in countries where creation of an ileostomy is problematic.