Ileostomy Closure: An Impasse Due to Adhesions

Abstract

In 1975, cholecystectomy was performed for gallstones. In 1982, appendectomy for gangrenous appendicitis was followed by several operations for a pelvic abscess. During 1996, episodes of acute small bowel obstruction necessitated 3 admissions to the hospital. Laparotomy (9.19.96) revealed small bowel obstruction due to extensive adhesions. Complete adhesiolysis of small bowel was performed with repair to several sites of the bowel wall. The obstruction failed to settle over the subsequent 17 days and reoperation was necessary. Laparotomy (10.6.96), revealed a “mass of matted bowel with adhesions rock solid, like concrete.” Extensive dissection resulted in ischemia to segments of small bowel and the left colon. A “massive” resection of ileum was performed (leaving 100cm of small bowel), and the left colon was resected as a Hartmann operation. Subsequent to this operation, a small bowel fistula presented in the lower part of the abdominal wound. It failed to heal with conservative treatment. The patient was referred for further management.