Protective "Tube" Cecostomy: An Alternative to Enterostomy.

Sir,

Leakage from colonic anastomosis is a dreaded complication in pediatric colorectal surgery. It usually presents as generalized peritonitis requiring a major reoperation and construction of a proximal diversion in the form of either ileostomy or a proximal colostomy.[1] This may increase the morbidity and increase the physical, emotional, and financial burden on the family and caregivers of these children.

Cecostomy has been a controversial procedure since its inception in 1710 by Littre, and the indications of tube cecostomy in protection of distal anastomosis are not clearly defined, especially in the pediatric population.[2] Pediatric surgeons worldwide are adept with tube cecostomies in managing fecal continence and MACE procedures, but there is little mention of this as a drainage procedure in current literature.

We recently encountered two patients where we successfully used tube cecostomies to decompress the bowel and protect the distal anastomosis.

The first patient was a 3-year-old boy who had undergone Martin's modified Duhamel's procedure for rectosigmoid Hirschsprung's disease. On postoperative day 6, he leaked from the Martin's anastomosis. He was taken up for a relook laparotomy and the anastomotic dehiscence was repaired, and a covering tube cecostomy was done to provide the protective cover to the redo anastomosis. He was started orally on day 3, and the tube cecostomy was left on open drainage. After day 9, the tube cecostomy was removed bedside and the patient was discharged uneventfully [Figure 1].

Figure 1

(a) Dehisced Martin's anastomosis, (b) tube cecostomy, (c) hitching to the anterior abdominal wall

The second patient was a 2-year-old boy who underwent redo colostomy closure after leak following PSARP done elsewhere. There were severe adhesions for which extensive adhesiolysis was done. His distal anastomosis was also protected with a tube cecostomy which was removed on postoperative day 10. He was also discharged successfully.

In both these patients, the tube cecostomy worked well and we could get away without ileostomy followed by reoperation for ileostomy closure.

Although conventional surgical practice may propose a loop ileostomy as a covering stoma for distal “difficult” anastomosis, tube cecostomy may be a simple procedure to avoid the complications of “another” stoma in children.

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Conflicts of interest

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