RECONSTRUCTION OF INTESTINAL TRANSIT WITH MODIFIED KONO-S ANASTOMOSIS (ILEO-CECAL) IN A PATIENT WITH CROHN'S DISEASE

Case Presentation ALS, 35 years old, female, was admitted with daily diarrhea, nausea, vomiting, and progressive weight loss. Associated with these symptoms, she presented with amenorrhea, hair loss, asthenia, and malaise. Laboratory tests revealed leukocytosis. Imaging tests showed thickening with an inflammatory aspect in the distal ileum, extending to the cecum and cecal appendix, more accentuated near the ileocecal valve, associated with reactive mesenteric lymph nodes and coexisting cholelithiasis. Endoscopic examination revealed an irregular and friable lesion occupying the entire circumference of the cecum, preventing the passage of the endoscope through the ileocecal valve, with histopathological examination indicating chronic inflammatory process. She was diagnosed with Crohn’s disease and underwent surgical treatment, where intraoperative findings showed a localized mass in the right iliac fossa involving the terminal ileum, cecum, and transverse colon, with a fistulous tract between the terminal ileum and the transverse colon. A right ileocolectomy, transverse colostomy, terminal ileostomy (Brooke), and cholecystectomy were performed. She had an uneventful recovery. Later, she was hospitalized for intestinal transit reconstruction surgery, where a Kono-S ileocolic anastomosis was performed. She had no recurrence clinically or endoscopically.

Discussion Crohn's disease (CD) is an inflammatory disease characterized by transmural inflammation and asymmetric segmental involvement of the entire gastrointestinal tract. Approximately 20% of patients present with stenotic complications at the time of diagnosis, which can account for 40-70% of surgeries in the first 10 years of diagnosis. Unfortunately, postoperative recurrence of stenoses is common, especially at the ileocolic anastomosis site. The Kono-S anastomosis is based on the concept that inflammation in CD originates in the mesentery. Kono et al. proposed a terminal-to-terminal, antimesenteric anastomosis with the expectation of reducing disease recurrence.

Conclusion The Kono-S anastomosis technique has emerged as a promising option to prevent recurrence at the anastomosis site and reduce postoperative complications, with the advantages of preserving the diameter and dimensions of the anastomosis. Recent literature suggests that Kono-S anastomosis may become a standard surgical technique for CD. However, more clinical trials are needed to confirm the effectiveness of this technique.

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Artikel online veröffentlicht:
25. April 2025