PubMed · 3848442
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S Dudas. Expanding your practice.. https://doi.org/10.1097/00152192-198507000-00031
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Parastomal herniation is a frequent complication when an artificial anus is constructed. As a tunnel through the abdominal wall is nonphysiological, there is an inherent trend to enlargement of the aperture with any artificial stoma. However, none of the technical modifications tried has proved reliable in reducing the incidence of parastomal herniation. The only clear-cut indications for repair are ileus and incarceration or serious problems with the colostomy bags. There are three basic methods of repair: fascial closure, stoma relocation and augmentation of the abdominal wall by nonabsorbable meshes, and any of the three can be combined in many ways. The first two techniques each have a recurrence rate of 40%-80%, and neither can therefore any longer be recommended for use in isolation. Only with the last technique of abdominal wall reinforcement it is possible to achieve a recurrence rate of under 20%. The best type of mesh and the optimal implantation technique are still under discussion.
PURPOSE: We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. METHOD: A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. CONCLUSION: Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.
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