Gastrointestinal bleeding due to delayed perianastomotic ulceration in children.

Delayed perianastomotic ulcers are a poorly recognized complication of intestinal surgery. We report two patients with this complication of their remote intestinal surgery who developed significant iron deficiency anemia. Patient 1 had intestinal resection for perforated necrotizing enterocolitis as a newborn and presented at 16 yr of age with an ulcer at the ileocolonic anastomosis. Patient 2 had intestinal resection for strangulated internal hernia at 9 yr and was diagnosed with two ulcers at the ileoileal anastomosis at 14 yr of age. Fifteen patients with delayed anastomotic ulcers have so far been reported in the literature. We add two more cases and also emphasize the difficulty in establishing the diagnosis and importance of performing a retrograde ileoscopy.