Staged repair of colonic atresia with non-contiguous perforation of the proximal colon

Abstract

We present the case of a neonatal patient with colonic atresia who was transferred to our hospital for perforated peritonitis. In this case report, we describe the location of perforation and the treatment provided for the preservation of the ileocecum.A 2-day-old boy presented to our hospital in a state of shock, with continuous bilious vomiting and abdominal tension. His abdominal X-ray showed free and intestinal air; he was diagnosed with ileal atresia with perforation.The operative findings showed the perforation to be on the ascending colon just next to cecum and the atresia to be on the transverse colon. We were unable to complete a primary anastomosis. To preserve the ileocecum, an ileostomy was performed on the ileum 10 cm away from the ileal end. The perforation was repaired, and the colostomy was performed on the anal side of the atresic colon. Since 22 days of age, stool had been injected into the colostomy several times per day. The ileostomy was closed, and the atresic colon was anastomosed at the age of 77 days.This case suggests that the perforation site is not always near the site of atresia. When the perforation is near the ileocecum, performing an ileostomy can preserve the ileocecum from resection.

Keywords

• Colonic atresia
• Perforation
• Ileocecum
• Preservation
• Neonate