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The role and management of enterostomy in intestinal obstruction in infants

The American Journal of Surgery
Publication Date
DOI: 10.1016/0002-9610(63)90064-3
  • Design
  • Medicine


Abstract The history of use of the Mikulicz exteriorization resection in jejunoileac obstruction in infancy is reviewed. The double-barreled enterostomy is rarely employed now in adults but its revival over fifteen years ago as part of a two stage Mikulicz procedure was associated with a gratifying sustained improvement in survival rates in this demanding group of patients. Much of the condemnation of enterostomy in infants probably arose from the misconception that its role was that of a definitive therapeutic step rather than a temporary expedient designed to insure immediate effective decompression and safer anastomosis. Dissatisfaction with the continued poor results achieved by lateral anastomosis and reluctance to adopt the older, complicated exteriorization operation have led several surgeons to advocate primary end to end anastomosis during the past few years. Their demonstration of increasingly favorable recovery rates that rival those of the inherently less appealing staged procedure suggested that this review of the indications and rationale for choice of operative technic in specific situations might reveal opportunity for further improvement using a combined or flexible approach. The advantages and disadvantages of the Mikulicz procedure have been considered in the light of the specific and exacting demands of the surgical problems posed by neonatal intestinal obstruction. We believe that this admittedly less attractive staged procedure will continue to deserve use in certain small infants because: 1. 1. It can obviate the malfunction inevitable in the anastomosis of intestinal segments of tiny and disparate caliber. 2. 2. It provides immediate, effective, sustained decompression for the critically ill “fragile” infant. 3. 3. It provides the safest and most effective opportunity for evaluation and clearing of abnormal distal intestinal segments. 4. 4. It has been proved capable of a sustained high recovery rate in the hands of both widely experienced and resident surgeons. The essential steps and some of the important details in construction, care, and extraperitoneal closure of the double-barreled enterostomy have been outlined and illustrated. Some of our metabolic studies on infants with enterostomies are reviewed to show the common patterns of enterostomy loss of fluid and electrolyte and their use in a plan for satisfactory control and replacement. It is concluded that the Mikulicz procedure should still be part of the training of every general surgeon and, properly used, can salvage certain obstructed infants with relatively little chance of survival by primary anastomotic technics.

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