Question

A 6-year-old boy presented with life-threatening shock. CT showed large ascites, bowel wall thickening and poor or absent enhancement of a strangulated bowel segment, with gangrenous bowel found on surgical exploration. After resection, which statement about the intestinal anastomosis is TRUE?

• A. Should be done by continuous layers as it takes less time
• B. Should be done with catgut
• C. Should be done by single layer seromuscular Lembert sutures
• D. Should be done by single layer taking submucosa

Hint:

The Lembert suture is an inverting seromuscular stitch that does not enter the bowel lumen.

Answer 1

The Correct Option is C

Step 1: The picture is strangulated, gangrenous small bowel (here from an internal/transmesenteric hernia). After resecting the dead segment, a sound bowel anastomosis is needed. Step 2: A single-layer technique using seromuscular Lembert sutures is preferred. The Lembert suture is an inverting suture that approximates the seromuscular layers without entering the lumen, giving a serosa-to-serosa seal that heals well and avoids luminal narrowing. Step 3: Continuous suturing chosen merely to save time (option a) is not the principle; a purse-string narrowing and ischaemia can result. Catgut (option b) is an outdated, rapidly absorbed material not favoured for bowel anastomosis. Taking submucosa as a single layer that enters or relies on the lumen (option d) is not the described correct seromuscular technique. Step 4: Hence the true statement is single-layer seromuscular Lembert sutures (option c).