Successful Surgery for Type III Colonic Atresia Using the Side-to-Side Santulli Procedure: Rescue Treatment During the Practice of Global Pediatric Surgery

Colonic atresia (CA) is a rare congenital intestinal condition that requires surgical intervention. The surgical approaches for its treatment may vary from primary anastomosis to stoma creation. We report a case of CA treated with side-to-side anastomosis and Santulli-type colostomy. A three-year-old girl with a history of CA who had undergone ascending colostomy in the neonatal period visited the surgical mission of the World Surgical Foundation for definitive surgical management. The details of the operative findings in the neonatal period are unknown. Preoperative contrast enema revealed an unused rectosigmoid segment, suggesting that primary end-to-end anastomosis would be challenging. Exploratory laparotomy revealed type III CA in the ascending colon. The distal colon, from the transverse to the descending colon, was absent. Due to the 5-fold caliber difference between the ascending and sigmoid colon, a side-to-side Santulli procedure with an end colostomy was performed to restore colonic continuity. The procedure effectively restored intestinal continuity and addressed a significant caliber discrepancy. Postoperative recovery was uneventful, with consistent colostomy output and normal rectal stool defecation. Two months postoperatively, the patient remained in a good general condition and had a favorable bowel function. In conclusion, the side-to-side Santulli procedure offers a safe approach for CA, providing an additional safeguard as a pressure-release valve for cases with significant caliber differences between the proximal and distal colon, ensuring smooth stool passage.