A Preliminary Report in Efficacy of The Lateral T-Stoma: Solution for Functional Obstruction and Short Bowel Sydrome in High Jejunoileal Atresia

Abstract

Objective: This study is a preliminary report in the efficacy of lateral T-stoma (LTS), which we developed as a solution for anastomosis dysfunction and/or short bowel syndrome in the jejunoileal atresia (JIA). Method: The primary pathologies and results of all cases who underwent lateral t-stoma between July 2017-2020 were evaluated retrospectively. Results: Case 1 with meconium pseudocysts secondary to intrauterine volvulus had Type-3A JIA at 50 cm from the Treitz, and end-oblique anastomosis was performed. The LTS was created proximal to the first anastomosis. on Day 15 due to abdominal distension with 5/1 diameter ratio. The patient was discharged 13 days later. The LTS was closed in the 10th month. In Case 2 with Type-2 JIA at 60 cm from the Treitz, primary LTS was created proximal to the anastomosis with 5/1 diameter ratio. Patient was discharged 15 days later. The LTS was closed in the 10th month. End-to-side anastomosis was performed in Case 3 with Type-2 JIA located 70 cm from Treitz. Anastomotic leakage occurred on Day 36, and the LTS was created with 6/1 diameter ratio. The LTS was closed in the 5th month. Prenatally diagnosed Case 4 was postnatally intubated due to pulmonary hypertension, and surfactant was applied. Intrauterine volvulus, meconium pseudocyst and intestinal perforation were detected at 50 cm from the Treitz, and jejunoileal anastomosis together with primary LTS was performed with 5/1 diameter ratio. Nasogastric feeding started on the 10th day, but patient was lost on Day 44 without extubation. Primary repair and end-stoma were performed in Case 5 with gastroschisis/intestinal atresia with perforation. Due to high-flow stomal discharge/weight loss, the ileo-colic anastomosis and LTS were performed proximal to anastomosis with 3/1 diameter ratio at 60 cm from Treitz on Day 68. Patient was discharged on Day 90. In Case 6 with prenatal diagnosis as meconium cyst with Type-2 JIA (at 65 cm from Treitz), primary LTS was created proximal to the anastomosis with 4/1 diameter ratio. The LTS was closed in the 14th month due to high-flow stomal discharge. Conclusion: Creation of lateral T-stoma proximal to the anastomosis in JIAs with large differences in diameters may shorten hospitalization time and relieve functional obstruction/short bowel syndrome.

Keywords

• jejunoileal atresia
• meconium ileus
• neonatal obstructions
• enterostomy
• bishop-koop prosedure
• santulli.