Small-bowel plication prevents ileostomy prolapse in young children with inflammatory bowel disease.

Abstract

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 6months, 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 3cm 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.