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At least 253 records · Page 14Linked to original sources
PubMed1987

Penetrating right colon trauma. The ever diminishing role for colostomy.

Ninety consecutive patients with penetrating trauma to the right colon were analyzed. The severity of injury to the colon and other abdominal organs was quantified in each patient by the Colon Injury Score (CIS) and the Penetrating Abdominal Trauma Index (PATI). Sixty-five patients (72%) were managed definitively, i.e., by primary repair (46 patients) and by resection-ileocolic anastomosis (19 patients). There was no morbidity related to the colonic repair in these patients. Exteriorized repair was used selectively in eight patients and was successful in six (75%). Thirteen patients underwent loop colostomy and the mean CIS and PATI in this group were comparable to those in primary repair and exteriorized repair groups. Resection colostomy was performed in four patients with extensive colon and associated organ trauma (high CIS, PATI). The overall incidence of intra-abdominal abscess was 2.2 per cent (2 of 90 patients). The mortality was 4.4 per cent (4 of 90 patients) and none of the deaths was related to the management of the colon trauma. It is concluded that the majority of patients with penetrating right colon trauma can be treated effectively by primary repair or resection anastomosis. Exteriorized repair should be the preferred method whenever loop colostomy is considered. Colostomy should be used selectively in unstable patients who require colon resection.

Colon↗
PubMed1987

End colostomy using the end-to-end anastomosis instrument.

Gastrointestinal stapling instruments have achieved wide-spread application in intestinal surgery. Reported advantages of stapled bowel procedures compared to classic hand-sutured procedures include reduced tissue trauma, shorter operating time, and improved blood supply to the stapled bowel segment. A technique for creation of an end colostomy using the end-to-end anastomosis stapler (EEA instrument) is described. This technique was used in 11 gynecologic oncology patients who required colostomy. Postoperative stomal function was normal in all cases. No patient developed stomal necrosis, peristomal hematoma, or abscess. No delayed complications have been observed. Colostomy creation with the EEA instrument is a safe, simple and rapid procedure. Possible advantages of the stapled colostomy are enhanced blood flow to the stomal site, reduced incidence of peristomal infection, and improved appliance fit.

Adult↗
PubMed1984

End-loop colostomy.

A new method of "end loop" colostomy is described which avoids the conventional large bulky loop colostomy. The proximal and distal lumens can be easily irrigated or studied. The possibility of prolapse of the distal limb of the colostomy is minimized. After proper training in irrigation, the patients are able to use a stoma cap instead of colostomy bags.

Colostomy↗
PubMed1984

Comparison of early and late closure of transverse loop colostomies.

A retrospective study was made from the records of 100 consecutive patients who had closure of a temporary transverse colostomy at Addenbrooke's Hospital, Cambridge, between 1969 and 1982. Thirtyeight colostomies were closed early, approximately 2 weeks after the initial bowel resection and during the same hospital admission. The closure technique in the majority of cases involved resecting the bowel ends and performing a single layer anastomosis with interrupted Supramid. Statistically there was no difference in overall or individual complications, such as faecal fistulae and wound infections, in the early compared with the late colostomy closure group. The length of stay in hospital after closure was almost identical in both groups. This is true despite a higher proportion of operations in the early closure group being performed by less experienced surgeons. Early closure of a temporary colostomy is a relatively safe procedure and has obvious advantages for rehabilitation.

Aged↗
PubMed1980

Loop ileostomy--an attractive alternative to a temporary transverse colostomy.

Right-sided transverse colostomy and loop ileostomy when temporary used for protecting a new-constructed colorectal anastomosis were compared in two matched series of patients. The relative safety of the methods as expressed in complication rate on construction and subsequent closure and any difficulties associated with stoma care were assessed. The results indicate that a loop ileostomy, when properly constructed is well born even in elderly patients and is followed by a remarkably swift convalescence. Construction and closure appeared not to be associated with more difficulties or complications than transverse colostomy. As far as stoma care is concerned, transverse colostomy offered, if anything, more difficulties than the loop ileostomy. With modern appliances a loop ileostomy presents no more problems than a well-established conventional end ileostomy, and since a loop ileostomy is a more reliable defunctioning stoma than the transverse colostomy, it should probably be preferred when the primary purpose is to protect a colorectal anastomosis.

Aged↗
PubMed1993

Hidden colostomy.

For the patient with an unresectable carcinoma of the rectum, establishment of a "hidden" colostomy rather than formal colostomy, provides a better interim quality of life. When necessary, the "hidden" colostomy can readily be converted to a formal colostomy without the need for a laparotomy or general anesthetic. We conclude that surgeons should remember this technique when the appropriate situation occurs.

Colostomy↗
PubMed1994

Reversal of Hartmann's colostomy.

From January 1980 to December 1992, sixty-two Hartmann's procedures were performed for septic complications of sigmoid diverticular disease, in the Professorial Unit at Aberdeen Royal Infirmary. Colorectal continuity was subsequently restored in 53% of the fifty-three surviving patients. The overall morbidity and mortality was 34% and 0% respectively. There were two anastomotic leaks (7%) while two patients (7%) developed anastomotic stenoses requiring multiple dilations. Closure of Hartmann's colostomy was carried out by consultants (48%), senior registrars (38%) and registrars with consultant supervision (14%). Fifteen anastomoses were hand sewn and fourteen were stapled. Twenty-one per cent of patients had closure of colostomy in less than 3 months, 48% between 3 and 6 months and 31% of reversals were carried out more than 6 months following their formation. The grade of surgeon had no influence on the outcome of reversal. Although the numbers were small, the morbidity was found to be highest in those patients in whom colostomy closure was carried out within 3 months of colostomy formation. Also, there was an increased incidence (7%) of anastomotic stenoses in the stapled anastomosis group.

Adult↗
PubMed1994

Elective colostomy closure in an AIDS patient.

This article describes a 27-year-old patient with acquired immunodeficiency syndrome (AIDS) who underwent emergency sigmoid colostomy, Hartmann's pouch, and presacral drainage for rectal perforation. Three months later, he underwent uneventful elective colostomy closure, a procedure previously unreported in an AIDS patient. He remained without gastrointestinal symptoms for 14 months after colostomy closure until he died from central nervous system toxoplasmosis. A diagnosis of AIDS alone should not preclude colostomy closure in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Management of colostomies with plug: clinical aspects and patient evaluation].

AIM: To assess the effectiveness of the one-piece disposable plug device Conseal (Coloplast A/S, Espergaerd, Denmark) in colostomy patients, considering clinical and social aspects. PATIENTS AND METHODS: Twenty patients with definitive (perineal-abdominal amputation 17 cases) or transitory (Hartmann in 3 cases) colostomy were studied prospectively. No patient used self-irrigations. All of them completed the study. After obtaining the patient's consent, we analyzed for comfort, leaks, security, easy handling and skin conditions by means of personal interview and clinical examination. RESULTS: Sixteen patients (80%) had previously used conventional colostomy bags, 4 (20%) started to use the plug device during the postoperative period (average 8.7 days). Fifteen patients (75%) preferred to use the plug, whereas 5 (25%) considered the plug was insecure. CONCLUSIONS: Our study suggests that the one-piece disposable plug device improves the quality of life in patients with colostomy, although adequate selection of patients and previous training are mandatory.

Adult↗
PubMedDate not supplied

[The rehabilitation of colostomy patients].

The most rational way of managing colostomy patients was found to be alternate use of all the methods available for care of colostomy (control of its activity by avoiding misuse or favouring one of the above more than the others). Permanent colostomy is not contraindication to rational work. Just on the contrary, a habitual work distracts the patient's mind from thinking too much about his/her bodily defects. There is a need for a society of colostomy patients to be organized, who, with the help of the fund "Miloserdie" (Charity) could improve their rehabilitation.

Colon↗
PubMed1996

[Complications of colostomies. Follow-up study of 500 colostomized patients].

The complications of colostomies may constitute a handicap for patients: their prevalence severity and methods of treatment remain poorly known. 500 colostomy patients, with a mean age of 66 +/- 14 years, were retrospectively reviewed. The mean follow-up of the study was 6 +/- 5 years. Colorectal cancers represented 65% of the initial diseases. 59.5% of colostomies were terminal. They were performed for resection of the colon and or rectum in 56.5% of cases. 30.5% of patients (n = 152) presented complications (n = 235). The early complications (n = 147) observed in 29.5% of patients were mostly benign (20 required emergency operations). The late complications (n = 88), observed in 22.5% of 391 patients with a follow-up of more than one year required another operation in 1/3 of cases (11 cases of stenosis, 9 incisional hernias and 8 prolapses). Complications of colostomies remain frequent (one out of every 4 stomies ends in a complication) and the reoperation rate is situated between 13 and 33%. The therapeutic success rate of late reoperation is between 63 and 74%. When a reoperation is necessary, it should be ideally radical via a midline incision. The transposition technique gives better results than the repositioning technique via a local approach.

Abscess↗
PubMed1976

Effective colostomy irrigation.

The ultimate goal of the cone method of colostomy irrigation is to return patients with colostomies to their former role in society with confidence in themselves to the extent that having a colostomy is not considered a handicap. The results have generally been excellent. We believe all patients with stomas should be afforded the opportunity to attempt colostomy irrigation.

Colostomy↗
PubMed1997

[Restoration of bowel tube continuity in patients with colostomies].

The experience of restorative operations conducted within 1980-1995 in 186 patients with one-tube and separated two-tube colostomy gainred in proctologic clinic is reviewed. 179 patients suffered from cancer of the colon. The causes of performing colostomy are outlined. The main stages of restorative operation in two-tube colostomy are described. Peculiarities of colonic anastomosis formation after resection of bowel segment bearing fistula are considered, the resection being performed with the help of laser scalpel. Possibilities of the use of suturing apparatus AKA, peculiarities and advantage of its application in carrying out restorative surgical intervention in 69 patients after Hartmann's operation are demonstrated. The data of reconstructive-restorative operations in conditions of short rectal stump (modification of Duhamel operation), information about complications in restorative operations and their causes are analyzed. The mortality rate made up 2.2%. Possibility and expediency of restorative operations in patients with colostomy accompanied by metastases are discussed.

Adolescent↗
PubMed1990

The intracolonic bypass tube for left colon and rectal trauma. The avoidance of a colostomy.

Traumatic perforations of the left colon and rectum are most frequently managed by procedures that include the formation of a colostomy. Primary repair without colostomy is much less commonly employed. We report nine patients with traumatic perforations of the left colon and rectum treated with the intracolonic bypass tube (ICBT) without concomitant colostomy. In all these patients we believe the standard treatment would have included fecal diversion. Four patients sustained blunt trauma and five sustained penetrating trauma. Healing of the colonic anastomosis occurred in all cases, and the ICBTs were passed per rectum between the tenth and nineteenth days postoperatively. On the basis of this study, we conclude that the ICBT has a role in the treatment of selected injuries of the left colon and rectum as a safe means of avoiding a colostomy.

Adult↗
PubMed1985

Colostomy wound closure.

The management of the wound at the time of colostomy closure has been controversial, and wound infection is a frequently cited complication of this procedure. We have conducted a prospective randomized study of colostomy wound closure in 105 patients with three study groups: (1) primary closure (n = 38); (2) primary closure with subcutaneous drains (n = 29); and (3) delayed primary closure (n = 38). All patients had mechanical bowel preparation with whole gut lavage as well as oral neomycin sulfate/erythromycin estolate and perioperative parenteral cefazolin sodium (Ancef). Five wound infections (4.8%) occurred. Three infections were in the delayed primary closure group and one infection in each of the other two study groups. No statistical difference in wound infection was demonstrated. On the basis of the findings in this study, we would not recommend delayed primary closure for the management of colostomy closure wounds when careful mechanical and antibiotic preparation has been utilized.

Adult↗
PubMed1979

Loop colostomy closure.

The records of 74 patients who had loop colostomies closed at Addenbrooke's Hospital between 1970 and 1975 were studied retrospectively. One death from a pulmonary embolus occurred and the incidence of fistula from the site of closure was found to be 5.4 per cent. A number of differing factors were assessed. Closure 6 weeks after the colostomy's formation and preoperative antibiotic (antimicrobial) bowel preparation appeared to be factors associated with a favourable outcome. On the other hand, an initial operation for carcinoma and closure less than 6 weeks after the colostomy's formation were factors related to a less favourable outcome.

Adult↗
PubMed1980

Dependent proximal loop colostomy: does it defunction the distal colon?

The operation of dependent proximal loop colostomy is described. This colostomy avoids the complications of prolapse and paracolostomy hernia and is easy to close. It appears clinically to totally defunction the distal colon; his ability was studied by means of a radioactive tracer. Ten patients were given chromium-51 by mouth and it was found that none of this spilled over into the distal loop. It is concluded that dependent proximal loop colostomies effectively defunction the distal colon.

Colon↗
PubMed1985

Changing patterns in colostomy closure: the Bristol experience 1975-1982.

The results of colostomy closure in 113 patients (1975-1982) were examined to determine whether the identification of risk factors or improvements in surgical management had made this procedure safer. Overall mortality was low (0.9 per cent), but faecal fistulas occurred in 16.5 per cent and the incidence of wound infection was high (34 per cent). Comparison of the first and second 4 year periods shows recent improvements in the rates of wound infection (24 versus 51 per cent: P less than 0.01) and anastomotic leakage (10 versus 30 per cent: P less than 0.05). A long delay (greater than 6 months) between creation and closure of the colostomy was associated with an increased incidence of postoperative diarrhoea compared with shorter periods of defunction (38 versus 14 per cent: P less than 0.01). The morbidity of colostomy closure is decreasing but remains an important clinical problem.

Aged↗