Ileocolic Enteroenteric Fistula in Small Bowel Obstruction With Cecum Perforation in the Pediatric Age Group: A Case Report of a Rare Complication

Enteroenteric fistula in the pediatric age group is an unusual presentation. It can create a diagnostic dilemma for the physician, particularly in the absence of any previous surgery, prolonged abdominal symptoms, or inflammatory bowel disease. The patient is a 10-year-old girl who presented with mild-grade fever, abdominal distension, scanty stool passage, and foul-smelling vomiting for the past 10 days. Before this, the patient had received treatment for 20 days for her fever and diarrhea from a quack, and her symptoms had improved. There was no history of prolonged fever, chronic diarrhea, weight loss, blood in the stool, trauma, foreign body ingestion, or hospitalization for any medical or surgical condition. After resuscitation, the patient was evaluated with blood tests, serum tests, and other necessary investigations, and surgery was planned. Intraoperative findings included pyoperitoneum with dilated small bowel. The omentum was densely adhered to the distal ileum, causing distal ileal obstruction, with a perforation approximately 1 cm in diameter in the cecum. The appendix appeared normal. Ten centimeters proximal to the ileocecal junction, there was a nondistensible and redundant segment of the distal ileum with a nondissectible gangrenous omentum. This segment was causing complete obstruction of the small bowel contents. Just proximal to this segment, an ileotransverse colon fistula was present. A double-barrel ileostomy was created for the patient, and she was discharged on postoperative day 10. In pediatric intestinal obstruction, common causes include simple band obstruction, Meckel's band obstruction, intestinal adhesions, intussusception, and complicated appendicitis, among others. However, surgeons may encounter the unusual presentation of an enteroenteric fistula as a cause of intestinal obstruction.