Eur J Pediatr Surg 2007; 17(6): 426-427
DOI: 10.1055/s-2007-989268
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Beware of Stapled Side-to-Side Bowel Anastomoses in Small Children

C-C. A. Jackson1 , M. M. Bettolli1 , C. F. De Carli1 , J. Bass1 , S. Z. Rubin1 , B. Sweeney1
  • 1Department of General Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Further Information

Publication History

received May 4, 2007

accepted after revision June 19, 2007

Publication Date:
11 December 2007 (online)


Side-to-side, functional end-to-end stapled anastomosis (SS-EESA) is a frequently employed technique to re-establish continuity following bowel resection. We describe, for the first time in children, two cases of an important complication of this form of bowel anastomosis. Patient 1 had resection of a jejunal lymphangioma and formation of an SS-EESA at the age of 3 years. By the age of 7 years he was demonstrating symptoms consistent with malabsorption, which was confirmed by hydrogen breath testing. An upper GI contrast study indicated a segmental dilatation of the distal small bowel. Elective laparotomy revealed partial volvulus of a greatly dilated SS-EESA. Patient 2 had undergone bowel resection as a neonate for ileal atresia, with end-to-end anastomosis. An anastomotic stricture developed at two months of age that was resected with formation of an SS-EESA. Multiple ensuing episodes of partial small bowel obstruction were managed non-operatively until, at 5 years of age, she presented with complete bowel obstruction. At operation, volvulus of a hugely dilated SS-EESA was found. Intraoperative cultures of the succus entericus were consistent with bacterial overgrowth. Both patients were successfully treated with resection of the SS-EESA and primary anastomosis. SS-EESA can be complicated by bacterial overgrowth, massive dilatation and volvulus. In patients with SS-EESA who present with recurrent obstructive symptoms, this complication should be considered.


M. D. Brian Sweeney

Department of General Surgery
Children's Hospital of Eastern Ontario

401 Smyth Road

Ottawa, ON K1H 8L1