NEC small bowel stricture

A 28-week premature infant weighing 900 g was born with a tracheoesophageal fistula

The patient underwent successful ligation and gastrostomy tube placement for TEF

The patient developed necrotizing enterocolitis 3 weeks after TEF repair

NEC was treated medically, but the child developed a stricture shown on upper GI at 8 weeks of age

Three ports were used: a 4 millimeter 30 degree scope and two 3 millimeter ports, with the right-handed port later changed to 5 mm for the stapler

A Meckel's diverticulum was discovered while running the bowel proximally from the ileocecal valve

The stricture was located at approximately mid ileum

A loop of bowel was densely adherent to the capsule of the spleen at the point of obstruction

The 3 millimeter sealer was used to gently dissect the bowel off the spleen, preserving the splenic capsule with no bleeding

A small enterotomy was made during mobilization, which was later used to show the exact site of the obstruction

Forceps passed through the enterotomy showed complete obstruction of the bowel at the stricture site

The 5 millimeter stapler lays down 2 millimeter staples in 4 rows which are then divided between two rows equally

A 3-0 Prolene stitch was passed through the anterior abdominal wall and then through the two ends of the bowel to set up a side to side anastomosis, providing excellent exposure and acting as a retractor

A 3-0 Vicryl suture was used intracorporeally to align the proximal end of the anastomosis

The residual enterotomy after stapled anastomosis was closed with a running 3-0 Vicryl suture

Because of the very small intraabdominal space, only a limited portion of the trocar can be inserted into the abdominal cavity

A 3 millimeter bowel clamp was used to compress the base of the Meckel's to ensure all gastric mucosa would be resected

The Meckel's diverticulum had normal mucosa

The thumb of a size 7 glove was used as a manufactured specimen bag for extraction through the 5 millimeter port

The entire operation took 75 minutes and the child tolerated the procedure extremely well

The resected specimen was approximately 3.5 centimeters in length

At one month after resection, the baby was tolerating feeds without problems