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PubMed1984

Management of a subcutaneous colostomy perforation. The role of a new synthetic skin.

Colostomy perforation is an infrequent but often disastrous and lethal complication. In the majority of patients, the traumatic perforation occurs during irrigation through the colostomy stoma. This case report reviews the clinical course of a patient with a subcutaneous colostomy perforation and the subsequent development of an extensive abscess. Aspects of the management included mobilization of the colostomy and thorough surgical debridement and drainage. In addition, the report introduces the use of the new semisynthetic biologic dressing, BioBrane. This synthetic, semipermeable skin substitute served as a temporary dressing, provided good stability, and supported the application of a stoma appliance.

Abdominal Muscles↗

PubMed1988

An assessment of colostomy irrigation.

One hundred patients with permanent sigmoid colostomies were surveyed to determine their satisfaction and success with the "irrigation" technique of colostomy management. Most patients who irrigate their colostomies achieve continence. Odors and skin irritation are minimized. The irrigation method is economical, time efficient, and allows a reasonably liberal diet. It avoids bulky appliances and is safe. In appropriately selected patients, the irrigation technique is the method of choice for management of an end-sigmoid colostomy.

Adult↗

PubMed1983

The left transverse colostomy.

The right transverse colostomy is the one traditionally performed for distal colonic obstructive tumors, perforated sigmoid diverticulitis, distal colonic injuries, or for the protection of precarious low colonic anastomoses. However, the right transverse colostomy has a tendency to prolapse; its effluent is frequently liquid; it cannot be performed without producing adhesions in the right upper quadrant; and it obligates the surgeon generally to three operations when done as the first part of a staged colonic resection. The left transverse colostomy has the advantages of a reduced incidence of prolapse, an increased length of absorptive surface, absence of adhesions in the right upper quadrant, and the possibility of a two-stage resection. Fifteen instances in which left transverse colostomies were performed with diverse indications formed the basis for this report.

Colonic Diseases↗

PubMed1982

Closure of terminal and loop colostomy.

The clinical course after closing of a temporary colostomy was studied in 56 patients, 26 with loop colostomy and 30 with terminal colostomy. No significant difference was found in the complication rate or hospital stay between the two groups. It is concluded that terminal colostomy is preferable, as a standard procedure, because it is more acceptable to the patient and gives a complete diversion of the fecal stream.

Adolescent↗

PubMed1978

Hidden-loop colostomy.

Records of 15 patients having hidden-loop colostomies were reviewed. All patients had metastatic colonic cancers with impending obstructions. Six colostomies were subsequently opened because of obstructions due to cancer. All colostomy openings were done using local anesthesia in the emergency room. This technique prevented six major celiotomies and provided additional time of living without a stoma. There were two postoperative stomal prolapses, one of which necessitated reoperation. A hidden-loop colostomy is easily constructed and readily opened. It should be considered at celiotomy for selected patients who have metastatic colonic cancer with impending obstruction.

Abdomen↗

PubMed1999

Anal transposition without colostomy: functional results and complications.

Rectovestibular fistula (RVF) is the most common form of anorectal anomaly in female infants. In the surgical repair of these malformations, most pediatric surgeons use cutback, fistula transposition with or without colostomy, and lately, posterior anorectoplasty with colostomy. This is a retrospective evaluation of the functional results and complications in 47 patients who underwent fistula transposition without colostomy for the treatment of a RVF. We prefer to perform the operation when the rectovaginal septum is amenable to dissection (width >2 mm). All patients had voluntary bowel movements; 28 (60%) had completely normal bowel habits, 45 (96%) good and only 2 (4%) fair. We did not encounter serious surgical complications such as infection dehiscence, and fistula recurrence. We thus prefer anal transposition without colostomy to other modes of surgical therapy for RVF.

Anal Canal↗

PubMed1975

Repair of peristomal colostomy hernias.

Peristomal herniation represents the second most common late complication of abdominal wall enterostomy. Early herniation results from the creation of too large of a fascial defect. Late herniation is caused by a gradual enlargement of the fascial defect because of a poor selection of the colostomy site or an intrinsic weakness of the fascia due to the patient's age or general condition. Once peristomal herniation occurs, operative repair should be considered in an otherwise healthy person. Previous reports advocate primary repair of the herniation. In the present series of nine patients, three patients developed recurrence of the hernia six to eight months after primary repair. Six patients had colostomy hernia repairs that involved moving the site of the original stoma. All of these repairs remain intact at an average of two years, nine months (range, four months to six years). We therefore believe that the solution to the problem of recurrent colostomy herniation lies in the transposition of the site of the original colostomy.

Aged↗

PubMed2002

The use of temporary diverting colostomy to manage elderly individuals with extensive perineal burns.

The regimen of burn treatment for five elderly individuals who had sustained burns that had involved the perineum included formation of colostomy to divert fecal passage. The inclusion of diverting colostomy in this group of patients had made the management of burn wound that had included eventual skin grafting technically easy. A total of 168 patients were admitted to the Burn Unit at the Kagoshima City Hospital between 1997 and 2000. There were 36 patients who had perineal involvement. Of these, there were five elderly patients aged 60 years or older. There were two men and three women who were between 60 and 81 years of age. The mean age was 72 years. The total body surface involvement varied between 7 and 55% with an average body surface involvement of 30%. The sigmoid colon was as the colostomy site. Although, two patients died of injury, the morbidities associated with colostomy procedure were nil.

Aged↗

PubMed2006

Simple device for treating prolapsing loop colostomy.

Stoma prolapse is a common complication of intestinal stoma. Although various surgical methods yield satisfactory results, nonsurgical treatment may be better for a temporary stoma. We report a case of a patient with a distal limb prolapse of a right transverse colostomy who received nonsurgical treatment with satisfactory results. For the treatment of a temporary transverse loop colostomy with distal limb prolapse, we designed a simple device consisting of a pediatric plastic medicine cup, which was rolled into a towel to shape the bottom of the cup into a compressor. The towel was put on the stoma outside of the colostomy bag with the compressor above the prolapsing limb of the colostomy. An abdominal binder was applied to fix the towel.

Child, Preschool↗

PubMed2000

Experimental study of faecal continence and colostomy irrigation.

BACKGROUND: Colostomy irrigation is a useful method of achieving faecal continence in selected conditions, but remains largely underutilized because it is time consuming. This study investigated the effect of modifying irrigation technique (route, infusion regimen and pharmacological manipulation) on colonic emptying time in a porcine model. METHODS: An end-colostomy and caecostomy were fashioned in six pigs. Twenty markers were introduced into the caecum immediately before colonic irrigation. Irrigation route (antegrade or retrograde), infusion regimen (tap water, polyethylene glycol (PEG), 1.5 per cent glycine) and pharmacological agent (glyceryl trinitrate (GTN) 0.25 mg/kg, diltiazem 3.9 mg/kg, bisacodyl 0.25 mg/kg) were assigned to each animal at random. Colonic transit was assessed by quantifying cumulative expelled markers (CEM) and stool every hour for 12 h. RESULTS: Mean CEM at 6 h for bisacodyl, GTN and diltiazem were 18.17, 12.17 and zero respectively; all pairwise differences in means were significant (P < 0.001). The difference at 12 h between the two routes (P = 0.001) and three fluids (tap water 6.75, glycine 14.83, PEG 16.33; P < 0. 001) was significant, but not for PEG versus glycine and bisacodyl versus GTN. Cumulative output was significantly more with the antegrade than retrograde route using PEG, but the difference in mean cumulative output for bisacodyl and GTN at 12 h was not significant. CONCLUSION: Colonic emptying is more efficient with antegrade than retrograde irrigation. PEG and glycine enhance emptying similar to bisacodyl and GTN solution. These findings show promise for improved faecal continence by colostomy irrigation and may justify construction of a Malone conduit at the time of colostomy in selected patients who wish to irrigate. Presented in part to the British Society of Gastroenterology in Glasgow, UK, March 1999, and published in abstract form as Gut 1999; 44(Suppl 1): A135

Analysis of Variance↗

PubMed2004

Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing.

BACKGROUND: Elevated intra-abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model. METHODS: Thirty-six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared. RESULTS: Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P=0.0003). Mean tissue hydroxyproline concentrations showed no difference (P>0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P=0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P=0.0009). CONCLUSION: Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.

Anastomosis, Surgical↗

PubMed2001

Pseudocontinent perineal colostomy following abdominoperineal resection: technique and findings in 49 patients.

AIM: This prospective study was designed to evaluate functional results following the creation of a pseudocontinent perineal colostomy (PCPC) using Schmidt's technique. METHODS: Functional results in 40 patients whose rectum was resected due to cancer and reconstructed by PCPC between 1989 and 1995 in our institution were evaluated. Anatomical and pathological features of cancers, surgical technique and post-operative care are described. Morbidity, functional results and degree of patient satisfaction are reported. Median follow-up was 45 months (18--87 months) and was completed in 100% of patients. RESULTS: There were no operative deaths. Twenty patients had post-operative complications and two patients had an early conversion to a definitive abdominal colostomy due to serious perineal complications. On a functional level, four patients had normal continence, 23 had gas incontinence, nine had occasional minimal soiling and two had incontinence requiring iliac colostomy. Eighty-six per cent of patients were either highly satisfied or satisfied with their continence. DISCUSSION: PCPC is a reliable technique that can be suggested as an alternative to a left iliac colostomy following amputation of the rectum due to cancer, provided that certain requirements are met: careful selection of patients, informed consent, flawless surgical technique and lifetime daily colic irrigation.

Adenocarcinoma↗

PubMed1992

Effect of colostomy on the utilisation of dietary nitrogen in the fowl fed on a low protein diet.

1. The effect of the inhibition of urine back-flow into the colon and caeca by colostomy on the utilisation of dietary nitrogen by fowls fed on a low protein diet and receiving free or restricted water supply was investigated. 2. Colostomy caused an increase in water excretion and a resultant increase in water intake to maintain water balance. 3. Colostomy tended to decrease nitrogen balance and nitrogen utilisation (N balance/N intake) to negative values, and these decreases became significant when water was restricted (P less than 0.05). 4. Excretory uric acid, ammonia, urea and total nitrogen were significantly increased after colostomy in water-restricted fowls (P less than 0.05), but such significant effects were not observed, except for ammonia, in fowls given water ad libitum. 5. It is concluded that the back-flow of urine into the caeca plays a significantly useful role in the utilisation of nitrogen in the fowl fed on a low protein diet especially when water intake is restricted.

Animals↗

PubMed1995

Effect of colostomy on the occurrence of dietary [15N]urea in intestinal contents, blood, urine and tissues in chickens fed a low protein diet plus urea.

1. The occurrence of 15N was examined in excreta for 10 h, and in intestinal contents, blood and tissues at 10 h after [15N]urea was fed to conventional and colostomised cockerels. 2. Total-15N excretion and 15N-balance in control chickens were 18.88 and 44.79 mg/kg body weight/10 h), respectively. The former was increased and the latter was decreased by colostomy by 10.75 mg (P < 0.01). 3. Amounts of [15N]urea, [15N]ammonia and [15N]uric acid excreted by control birds were 13.78, 3.90 and 0.18 mg/kg body weight/10 h or 0.73, 0.21 and 0.01 of the total-15N excreted respectively. 4. The [15N]urea, [15N]uric acid and total-15N excreted were all increased after colostomy but [15N]ammonia was decreased (uric acid P < 0.05, others P < 0.01). The increase in total-15N was mostly accounted for by [15N]urea. 5. Colostomy resulted in significantly less total-15N in the contents of the whole intestine (P < 0.01), less total-15N, [15N]ammonia and [15N]urea in the contents of the colo-rectum (P < 0.01) and less total-15N and [15N]urea in the contents of the upper intestine (P < 0.05); it did not affect any in caecal contents. 6. [15N]Urea in blood, liver and kidney (blood P < 0.01, others P < 0.05), and [15N]glutamine amide (P < 0.05) and [15N]uric acid (P < 0.01) in blood were significantly decreased after colostomy. 7. The results support the hypothesis that most of the dietary urea is utilised as the result of a back-flow of ureteral urea into the caeca where it is rapidly converted into ammonia which is then metabolised to other compounds.

Animal Feed↗

PubMed1989

Colostomy and drainage for civilian rectal injuries: is that all?

One hundred consecutive patients with injuries to the extraperitoneal rectum were treated over a ten-year period at an urban trauma center. The mechanisms of injury included firearms in 82 patients, stab wounds in 3 patients, a variety of other penetrating injuries in 10 patients, and in 5 patients the injuries resulted from blunt trauma. Treatment of the rectal injury was determined by the bias of the operating surgeon, the condition of the patient, and the magnitude of the rectal injury. Proximal loop colostomies were performed in 44 patients, diverting colostomies in 51 patients, Hartmann's procedure in 4 patients, and an abdominoperineal resection in 1 patient. Extraperitoneal rectal perforations were closed in 21 patients and the rectum was irrigated free of feces in 46 patients. Transperineal, presacral drainage was used in 93 patients. Infectious complications potentially related to the management of the rectal wound occurred in 11 patients (11%) and included abdominal or pelvic abscesses (4 patients), wound infections (6 patients), rectocutaneous fistulas (3 patients), and missile tract infections (2 patients). Four patients (4%) died as a result of their injuries. Of the therapeutic options available, statistical analysis revealed that only the failure to drain the presacral space increased the likelihood of infectious complications (p = 0.03); however, as it could not be determined with certainty that the use of, or failure to use, any particular therapeutic option had an effect on the risk of death. It is concluded that colostomy and drainage are the foundations of the successful treatment of civilian injuries to the extraperitoneal rectum. The use of adjuncts such as diverting colostomies, repair of the rectal wound, and irrigation of the rectum has little effect on mortality and morbidity.

Adolescent↗

PubMed1989

Indications for barium enema preceding colostomy closure in trauma patients.

The need for a barium enema (BE) preceding colostomy closure is controversial. In the process of evaluating the usefulness of BE before closure of colostomies performed for colorectal injuries, we reviewed our experience with 84 trauma patients who underwent BE before colostomy closure. Patients who had their colonic injuries repaired or diverted during the initial procedure did not benefit from the precolostomy closure contrast study. In this group of patients artifacts on BE had to be ruled out by endoscopy or repeat radiography in 9.5% of patients. Barium enema was found beneficial in evaluating colorectal injuries below the peritoneal reflection in one out of 20 patients. However, since the rectal injuries are not usually explored and repaired during the initial procedure, investigation by endoscopy and contrast studies may still be indicated preceding colostomy closure.

Adolescent↗

PubMed1998

Is colostomy always necessary in the treatment of open pelvic fractures?

BACKGROUND: Wound management in open pelvic fractures has used fecal diversion, debridement, and closure by secondary intention to prevent pelvic sepsis. Colostomy care and takedown adds to the morbidity and resource utilization of this approach. We reviewed our experience to determine if a selective approach to fecal diversion based on wound location was possible. METHODS: Retrospective analysis of patients admitted to a Level I trauma center during an 8-year period. Fractures were classified as open if the fracture was in continuity with the wound. Wounds were classified as perineal if they involved the rectum, ischiorectal fossa, or genitalia, and as nonperineal if they involved the pubis anteriorly, iliac crest, or anterior thigh. Pelvic sepsis was defined as cellulitis, fasciitis, or infection of a pelvic hematoma. Diversion consisted of loop or end colostomy. RESULTS: Eighteen patients with open fractures were identified. Four died from closed head injury and blood loss. The remaining 14 were treated as follows. Five patients with perineal wounds had diversion of their fecal stream. Their Injury Severity Score was 34 +/- 8.3 and their Revised Trauma Score was 7.69 +/- 0.15. No patient developed pelvic sepsis. Nine patients with nonperineal wounds did not undergo diversion. Their Injury Severity Score was 28.6 +/- 5.3 and their Revised Trauma Score was 7.36 +/- 0.45. No patients developed pelvic sepsis in the nondiverted group. CONCLUSION: No patients with anterior wounds and an intact fecal stream developed pelvic sepsis. Colostomy may not be necessary in all patients with open pelvic fracture. Protocols using fecal diversion based on wound location appear to be safe and may decrease resource utilization and subsequent morbidity related to colostomy closure.

Adult↗

PubMedDate not supplied

A pilot study assessing the effectiveness of a glycerin suppository in controlled colostomy emptying.

UNLABELLED: The focus of this research was to explore another way for the patient to manage their colostomy. It was hoped that by inserting a glycerin suppository into the colostomy one would be able to evacuate the lower large intestine more effectively and efficiently. OBJECTIVE: To determine if persons with a sigmoid colostomy could obtain fecal continence by instituting a daily self-administered bowel-stimulating suppository. DESIGN: Randomized crossover comparative study comparing usual ostomy emptying practice with emptying with a glycerine suppository to stimulate controlled emptying. SETTING AND SUBJECTS: Adult males and females with a sigmoid colostomy were studied in their homes. INSTRUMENTS: The instruments included a profile questionnaire, a take-home diary, crossover and end-of-study questionnaires, and an exit questionnaire. METHODS: Subjects were randomized to their usual pouching method or to the experimental suppository method for 14 days each. RESULTS: There was no difference in fecal output, fecal volume, or flatus between the 2 groups. The action of the suppository was affected by its failure to remain in the bowel for an adequate amount of time. CONCLUSION: Further research is needed to determine if an adjunct device/method to hold the suppository in place would produce successful results.

Adult↗