Emergency ileo-cecal anastomosis with inclusion of appendicular stump in terminal ileal pathology: A newer approach

Abstract

Background: In emergency settings, several surgical procedures are described while dealing with pathology of terminal ileal lying within 15 cm of the ileocecal valve, but there is still confusion and controversy over the optimal surgical treatment.

Methods: A nonrandomized study of 210 patients with near terminal ileal pathology (within 15 cm) was carried out over a period of 10 years. The study included 112 cases in which an ileocecal anastomosis with inclusion of appendicular stump was used in terminal ileal pathologies, and in rest 98 cases, other surgical procedures were used. The outcomes were measured in relation to postoperative complications and mortality.

Results: Postoperative complications encountered in emergency ileocecal anastomosis with the inclusion of appendicular stump were wound infection in 31 patients (34.72%), respiratory complications in 10 patients (11.2%), septicemia in 6 patients (6.72.%), and anastomotic leak in one patient (1.12%).

Conclusion: The technique of ileocecal single‑layer anastomosis with the inclusion of appendicular stump was found to be very effective in dealing this common problem and had less morbidity and mortality.

Keywords: Ileocecal anastomosis, multiple terminal ileal perforations, single layer anastomosis, terminal ileal gangrene