Mirza, Bishop-koop stoma prolapse

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An Interesting Case of Bishop-Koop Stoma Prolapse

Bilal Mirza

A 4-month-old male baby presented with enterostomy

prolapse. Past medical history revealed two operations
elsewhere during third week of life. The first operation
was performed for pneumoperitoneum due to necrotizing
enterocolitis (NEC) of distal jejunum. The involved portion
of small intestine was resected and a primary end-to-end
jejuno-ileal anastomosis performed. The patient had to be
re-explored due to anastomotic disruption and then an
end-to-side jejuno-ileal anastomosis with Bishop-Koop
ileostomy fashioned [Image 1]. The patient remained well
for three months and passed stool per rectally and
occasionally from stoma.

The patient on arrival was vitally stable with normal labs.

The general physical and systemic examinations were
unremarkable besides a prolapsed enterostomy. Patient
Image 1: A line diagram illustrating end-to-side jejuno-ileal
was anesthetized. The prolapse was inverted Y shaped,
anastomosis with Bishop-Koop ileostomy.
with the first limb the original Bishop Koop prolapse of
ileal mucosa; whereas the second limb was the prolapsed
The basic purpose of a Bishop-Koop enterostomy, in
mucosa of jejunum through end-to-side jejuno-ileal
patients of meconium ileus, is to provide a vent for and
anastomosis. The mucosal anastomotic line was visible
irrigation of the distal bowel having thick inspissated
at the proximal part of that limb [Image 2]. Initially the
meconium. In other pediatric surgical conditions, it is
jejunal mucosa was returned back to the main stump
being used as a safety guard for intestinal anastomosis
followed by reduction of ileal mucosa. U-stitches were
where a diversion enterostomy is not desirable like stoma
applied to hold the mucosa in place [Image 3]. Patient
in very proximal part of intestine and in conditions where
was discharged after 2 days and appointment given for
intestinal length is short [3].
reversal of stoma.
Enterostomies are associated with many problems such
DISCUSSION
as; stoma retraction, prolapse, narrowing, peri-stomal
hernia/evisceration of intestine, bleeding, skin
Enterostomies are commonly made for various pediatric
excoriations, wound dehiscence, and so on. In one study
surgical conditions. Different types of enterostomies
enterostomy related complications were about 68% in
include loop, divided/double barrel, Hartmann, santulli,
children of different age groups. The incidence of
Bishop-Koop etc. These may be classified as temporary
prolapse in pediatric patients ranges between 3% and
or permanent depending upon the underlying condition
25%. The incidence of stoma prolapse is higher with loop
for which they have been formed [1,2].
enterostomy and minimum with divided enterostomy. The
Bishop-Koop enterostomy was originally devised for the highest prolapse (25%) is observed in the distal stoma of
patients with meconium ileus, but, it has also been used transverse loop colostomy [4].
for other pediatric surgical conditions such as intestinal
In temporary ostomies, the stoma prolapse is usually
atresia and NEC. Forming a Bishop Koop stoma involves
managed conservatively, however in cases where the
anastomosis of end of proximal bowel to the side of distal
stoma is desired for a longer period or in case of
bowel and exteriorizing the end of distal bowel as
permanent enterostomy, a revision of the stoma has been
chimney -enterostomy [Image 1] [2,3].
advocated [5,6].

APSP J Case Rep 2010; 1: 24 1

 Mirza, Bishop-koop stoma prolapse

prolapse of not only intestine but also adjacent

anastomosis.

REFERENCES

1. DelPino A, Citron JR, Orsay CP. Enterostomal

complications: are emergently created enterostomas at
greater risk? Am Surg 1997; 63:653-6.

2. Gauderer MWL. Stomas of the small and large intestine.

In: Grosfeld JL O’Neill JA Jr, Coran AG, Fonkalsrud EW,
th
Caldamone AA. editors. Pediatric surgery. 6 ed.
Chicago: Mosby Elsevier; 2006. p. 1479-91.

3. Ziegler MM. Meconium Ileus. In: Grosfeld JL O’Neill JA

Jr, Coran AG, Fonkalsrud EW, Caldamone AA. editors.
th
Image 2: The Prolapse of ileal and jejunal mucosa along with Pediatric surgery. 6 ed. Chicago: Mosby Elsevier; 2006.
anastomotic line of end-to-side jejuno-ileal anastomosis is evident. p. 1289-303.

4. Sheikh MA, Akhtar J, Ahmed S. Complications/problems

of colostomy in infants and children. J Coll Physicians
Surg Pak 2006; 16: 509-13.

5. Duchesne JC, Wang YZ, Weintraub SL. Stoma

complications: a multivariate analysis. Am Surg 2002;68:
961-86.

6. Shellito PC. Complications of abdominal stoma surgery.

Dis Colon Rectum 1998;41:1562-72.

Bilal Mirza

Image 3: After reduction of prolapsed enterostomy. Address: Department of Paediatric Surgery, The
Children’s Hospital & The Institute of Child Health Lahore,
In a perusal of English literature through “Pubmed Pakistan.
website” using keywords “Bishop Koop” and “prolapse” Email: blmirza@yahoo.com
no relevant paper was found. The prolapse of Bishop-
Received on: 05-08-2010 Accepted on: 25-08-2010
Koop stoma is therefore a rare event. This may be due to
a very small caliber stoma in cases with meconium ileus http://www.apspjcaserep.com © 2010 Mirza
where it was primarily recommended; however, in our This work is licensed under a CreativeCommons
case, NEC was the primary diagnosis thus caliber of Attribution3.0UnportedLicense
Bishop-Koop stoma was not small. This contributed to the

How to cite

Mirza B. An interesting case of Bishop-Koop stoma prolapse. APSP J Case Rep 2010; 1: 24

APSP J Case Rep 2010; 1: 24 2