Primary intestinal anastomosis in a child with perforation of Meckel's diverticulum and peritonitisauthors

A case-report of the treatment of a 13-year-old child with Meckel's gangrenous-perforative diverticulitis complicated by diffuse peritonitis is presented. The perforation localized at the base of Meckel's diverticulum, therefore ileal resection was performed. The presence of peritonitis required a difficult choice of further surgical management - the stoma formation or performing a primary intestinal anastomosis. Nowadays, it is considered an enterostomy to be the most reliable and rational surgical option after bowel resection in peritonitis conditions. However, this issue has become increasingly controversial. There are many publications which testify to the success of primary intestinal anastomosis, regardless of the peritonitis severity and the 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 observation the child underwent primary intestinal anastomosis, despite the presence of an 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 the absence of significant hydrobalance disorders. There were no complications in the postoperative period. The child was discharged on the seventh postoperative day. We aimed to evaluate our experience with the primary anastomosis approach in peritonitis condition.