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Session: ePoster: Quality and Cost 9 (Sat315)

EP156 - Diverting Tube Ileostomy - A Diversion Technique For A Low Pelvic Anastomosis Without The Need For A Second Reversal Procedure

Saturday, May 10, 2025
3:25 PM – 3:30 PM PT
Location: Monitor 8, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Mahin Janjua, MBBS

    Surgery Resident
    Howard University Hospital and College of Medicine
    Washington, DC, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • CN

    Christine Nembhard, MD, FACS

    Assistant Professor
    Howard University Hospital
    Washington, DC, US

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • QC

    Quyen Chu, MD, FACS, MBA

    Professor
    Howard University Hospital
    Washington, District of Columbia, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Mahin Janjua, MBBS: This individual has no financial relationships with ineligible companies.
Christine Nembhard, MD, FACS: This individual has no financial relationships with ineligible companies.
Quyen Chu, MD, FACS, MBA: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: On occasions, patients who present with a perforated/obstructed pelvic mass might require a resection with a colostomy (Hartmann procedure), or a resection with primary anastomosis followed by a diverting loop ileostomy. Up to 30%-40% of those with a colostomy never undergo a reversal. For those with a loop ileostomy, a second operation is required. We present a novel technique that allows for primary anastomosis without a need for a second reversal operation.

Methods/Interventions: A diverting tube ileostomy was created by using an 18 French red catheter that is inserted into the proximal segment of the loop of terminal ileum and exteriorized. The distal portion of the terminal ileum is encircled with a 4-0 Prolene that is brought to the skin and loosely tied to allow bowel rest to the colorectal anastomosis. On postoperative day (POD) 7-14, the anastomosis is assessed for a leak with a Gastrografin enema. It there is no leak, the Prolene suture is cut to restore GI continuity and the red rubber catheter is then removed in clinic on POD 14-21. The ileo-cutaneous fistula from the red catheter seals within 24 hours, thus avoiding the need for a second reversal operation.

Results/Outcomes: We successfully applied this novel technique on three patients who had variable urgent/emergent presentations. All had a low anterior resection with primary anastomosis and a diverting tube ileostomy and none required a second reversal operation.

Conclusion/Discussion: This novel technique is a potential option for those who required a low anterior resection since it avoids the need for a colostomy as well as a second operation to reverse a loop ileostomy.