Methods: Case report Results: A 16-month-old female patient is reported, with a history of gastroschisis, presence of short bowel syndrome without ileocecal valve, resolved liver failure. Initially with ileostomy with 35 cm of small intestine; Seeking to improve progression of the enteral route and intestinal adaptation, ileostomy closure and subsequent colostomy were performed since there was suspicion of stenosis in the distal colon. It begins with events of sudden anemia, drop of 2 g of hemoglobin per day, requirement of transfusion support, associated with evidence of hematochezia by colostomy, the first endoscopy is performed by colostomy documenting small ulcers with evidence of eosinophilic colitis, she began management with prednisolone, elemental diet, without improvement. A 2nd time endoscopy was performed, perianatomotic ulcers were documented, with no evidence of active or recent bleeding. Complete evaluation of the intestine endoscopically was not possible. Medical management was started with mesalazine, sucralfate, and steroids were continued, with persistence of symptoms. Ischemic colitis is suspected, so the group decided to carry out a new surgical and endoscopic procedure simultaneously, where a segment of the small intestine with erythematous mucosa and an ischemic appearance is documented in the endoscopic assessment that is adjacent to the area of the small intestine anastomosis, which was resected, associated with an erythematous area and ulcer in the endoscopic assessment adjacent to one of the mechanical sutures of the previous intestinal lengthening, which was also resected. Surgery performs end-to-end anastomosis, resection of the proximal end of the narrow sigmoid colon, end-to-end colo-colonic anastomosis. Pathology reports the absence of ischemic changes in resected segments, with the presence of severe eosinophilia (unquantifiable). Patient since the last procedure without new events of gastrointestinal bleeding. Conclusion: Multidisciplinary work in patients with intestinal failure in the process of intestinal adaptation is essential. The performance of a hybrid endoscopic and surgical procedure, by pediatric gastroenterology and pediatric surgery, allowed the adequate identification of the affected segments, so that they were resected more precisely, achieving control of the symptoms in the patient, as well as the progression of the enteral nutrition.