Double-barrel ileocolonic stomy – A simple technique with an easy local reversal in emergency synchronous resections in Crohn's disease complicated with ileosigmoid fistula

Abstract text (incl. references and figure legends)

Introduction Internal fistulas are missed preoperatively in one-third of the cases. In complicated ileocecal localization and synchronous involvement of the sigmoid colon, the surgeon is always faced with the main question – to perform a stoma or not and what type of stoma to choose. According to the literature, the mean rate of stoma in these cases is 31%. Results From 2014 to 2022 a total of 70 operations on 56 patients were performed. Of them, 11 (19.6%) had ISF with a mean age of 32 years (20-47) and a mean disease duration of 7.3 years (2-12). All patients had a weight reduction of 15 kg (5-45), mean serum albumin of 33 g/l (26-43), and mean haemoglobin of 124 g/l. Preoperative diagnosis of ISF was set in 55% of cases. Five cases (45.5%) were operated on in an emergency setting. In four a double-barrel ileocolonic stomy was performed – ileoascendo stomy in three and ileo-transverse stomy in one. They were reversed through a local laparotomy and side-to-side functional mechanical anastomosis via GIA 100 mm and 80 mm one month later. In one case a proximal ileostomy was performed. All cases had an uneventful recovery. Conclusion ISFs occur in up to 20% of the operated patients. In case of right and left colonic resection in an emergency setting a double-barrel ileocolostomy is recommended because its easier reversal by local laparotomy and side-to-side mechanical anastomosis. An alternative to this approach is a proximal ileostomy, which was performed in one case.

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Nothing to declare.