Delayed occult gastrointestinal bleeding secondary to ulcer at site of neonatal ileoileostomy

Abstract

Meconium peritonitis occurs in neonates after an in-utero bowel perforation. It can sometimes be treated initially with peritoneal drainage, and usually will also require a laparotomy, possibly with enterostomy, in order to evacuate remaining intraluminal meconium to relieve the resulting bowel obstruction. In most neonates with enterostomies, the stoma can be closed and intestinal continuity restored when the patient has reached a sufficient weight and is healthy. Stricture of the anastomosis in such cases is a well-known complication. However, gastrointestinal bleeding from the anastomotic site is less common. Here, we present the case of a young lady who had a neonatal ileostomy followed by ileostomy closure, who developed chronic anemia from occult GI bleeding that did not present for more than a decade. An extensive workup revealed bleeding from the ileoileostomy site, diagnosed during a combined exploratory laparotomy and push enteroscopy procedure. It was treated by segmental small bowel resection with primary anastomosis.