Question

A 6-year-old boy developed life-threatening shock; his CT scan showed a large amount of ascites, bowel wall thickening, and poor or absent enhancement of a strangulated bowel segment. Surgical exploration revealed gangrenous bowel. Which of the following is TRUE about the bowel anastomosis?

• A. It should be done in continuous layers as it takes less time
• B. It should be done with catgut
• C. It should be done by single-layer seromuscular Lembert sutures
• D. It should be done by a single layer taking the submucosa

Hint:

Inverting suture that does not enter the bowel lumen.

Answer 1

The Correct Option is C

Step 1: The clinical picture is congenital internal hernia with strangulated, gangrenous small bowel, requiring resection and anastomosis. Transmesenteric hernia is the most common type in older children and neonates.

Step 2: The recommended technique is a single-layer seromuscular Lembert suture anastomosis, so option 3 is correct.

Step 3: The Lembert suture is an inverting suture used in abdominal surgery that can be continuous or interrupted and joins two intestinal segments without entering the lumen.

Step 4: Catgut is not preferred for bowel anastomosis, and the choices describing continuous-for-speed or submucosa-taking single layers do not match the recommended seromuscular Lembert technique, so options 1, 2, and 4 are wrong.