Ileostomies in children with chronic intestinal pseudoobstruction: When, where and why

The aim of this report is to review the literature about children with Chronic Intestinal Pseudo-Obstruction (CIPO), in order to discuss the actual managing approach, focusing on surgical contribution. Today CIPO is still a life-threatening disease, with high morbidity and mortality (up to 32 %), but without a definitive "cure". The use of venting ileostomies and Total Parenteral Nutrition was firstly reported in 1985 and is still the first and most common procedure performed in these patients. The ostomy should be performed proximally to affected bowel or on middle ileum when the whole small intestine is involved. The sooner the intestine is decompressed, the quicker residual motility is restored. Double divided loops ileostomies are easier to manage both in hospital and at home; prolapse and abundant fluid loss are reported complications. Intestinal transplantation is a feasible surgical option, indicated in selected patients with TPN-related liver failure, septic episodes and limited venous access.