| Summary: | Objectives: Perianastomotic ulceration (PAU) is an uncommon but potentially devastating condition, with a wide range of presenting symptoms. However, treatment approaches differ between centres as they are well known to be difficult to treat, and recurrences are common. Methods: This is a case series with literature review on PAU. We report 2 cases under the care of a tertiary pediatric surgical centre in Hong Kong with a background of neonatal necrotizing enterocolitis who underwent massive bowel resection, followed by small bowel to large bowel anastomosis. Results: The presentation of PAU was delayed for a median of 38 months, with varying severity of presentation from per rectal bleeding without need for transfusion to massive gastrointestinal bleeding requiring pediatric intensive care unit admission and immediate laparotomy. Recurrent bleeding was still evident in one of the patients after multiple courses of anti-inflammatory agents. Conclusions: PAU is a rare condition as a result of multiple factors and a consensus on management is lacking. Patients with short bowel syndrome with small to large bowel anastomoses appear to be more prone to PAU development. Due to its delayed presentation, long-term follow up and regular surveillance for PAU for patients with short bowel syndrome is recommended. © 2022
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