Primary intestinal anastomosis in a child with perforation of Meckel’s diverticulum and peritonitis

Abstract

This paper presents the treatment course of a 13-year-old child with Meckels gangrenous-perforative diverticulitis complicated by diffuse peritonitis. The perforation was localized at the base of Meckels diverticulum; therefore, ileal resection was performed. Peritonitis required a difficult choice of further surgical management, i.e., stoma formation or primary intestinal anastomosis. Nowadays, an enterostomy is considered the most reliable and rational surgical option after bowel resection in peritonitis conditions. However, this issue has become increasingly controversial. Many studies have confirmed the success of primary intestinal anastomosis, regardless of the severity of peritonitis and degree of contamination of the abdominal cavity, even noting the advantages of radical treatment and prevention of various stoma-related complications. In the presented clinical case, the child underwent primary intestinal anastomosis despite the exudative inflammatory process in the abdominal cavity. This option was chosen because of the stable general condition of the child, satisfactory central and peripheral hemodynamics, and absence of significant hydrobalance disorders. No complications occurred during the postoperative period. The child was discharged on postoperative day 7. In this study, we aimed to evaluate our experience with the primary anastomosis approach in peritonitis.