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At least 343 records · Page 19Linked to original sources
PubMed1999

[Fournier's gangrene involving all of the scrotum: treatment by multiple repeated surgical excisions, diversion colostomy, triple antibiotic therapy and postoperative intensive care].

OBJECTIVES: To describe and analyse the proposed therapeutic modalities to treat a series of patients suffering from Fournier's gangrene involving the entire scrotum. MATERIAL AND METHODS: Four patients with macroscopically identical lesions of Fournier's gangrene involving the entire scrotum were managed by wide surgical debridement, diversion colostomy, triple combination antibiotic therapy, transfer to surgical intensive care, multiple repeated operations under general anaesthesia for excision of atonic tissues and mesh skin grafts. The colostomy was closed after 4 months. RESULTS: All patients survived after skin cover. Three of them were reviewed 2 months after restoration of gastrointestinal continuity and presented a good general status with a satisfactory esthetic result. The fourth patient was lost to follow-up. The mean reoperation rate was 6.5 per patient. The mean intensive care stay was 9.5 weeks. CONCLUSION: The choice of intensive treatment depends on the extent of the lesions. When the entire scrotum is involved, repeated surgical excisions and systematic colostomy, combined with the other treatment modalities appear to be necessary to manage this disease, which still has a serious prognosis.

Adult↗
PubMed2000

[Clinical evaluation of a new device for patients with colostomies].

INTRODUCTION: There are some 32,000 people in Spain who have undergone an osteotomy; of these, approximately 76% have a colostomy. While a patient undergoes rehabilitation, it is essential that the collecting device provide the patient security, cutaneous protection, effectiveness against odors and discretion; all of which can greatly help a patient to accept his/her new body image, to recover his/her self-esteem and to reincorporate into his/her normal life. In order to attend to the ever more demanding demands placed by this body of patients, a new closed one piece bag named "Alterna Ideal" has been developed. The purpose of this clinical test is to show the efficiency of this product under real treatment conditions. MATERIALS AND METHODS: This prospective, open multi-centric and non-comparative study permitted both patients and nursing professional to evaluate Alterna Ideal under habitual use conditions. Each patient tested 19 bags and made two check-ups with health professionals, one at the beginning of this study and the other at the end of it. Besides the demographic data, the evaluating parameters referred to the four elements which make up this device: an adhesive component, a filter, a soft cover and its shape. At the same time, the product as a whole was evaluated along with its duration, a patient's preference for it over the previously used product and the condition of the skin in the colon area at the beginning and the end of this test. To analyze data, descriptive statistics were used. RESULTS: This study included 187 patients, 54.5% were male and 45.5% female; average age was 61.9 years. The average stoma diameter was 33.7 mm; the average time since a patient underwent his/her colostomy was 25.2 months; 82.4% had surpassed one month since their osteotomy. 79.1% of these patients did not show any complication related to their osteotomy. The average length of use of these bags was 13.37 hours. Statistically significant differences were obtained regarding the condition of the skin in the colon area since this condition improved as this study progressed. These are the percentages of patients who rated each of these concepts as either good or very good: immediate application, 91.5%; feeling of security, 85.6%; flexibility and adaptability, 90.9%; effectiveness against leakage, 85.5%; removal, 91.5%; the filter's functioning, 88.2%; the shape of the bag, 92%; the quality of the soft covering, 94.7%; and overall rating, 92.5%. 75.9% of these patients who had previously used another product stated they preferred Alterna Ideal. These are the percentages of professionals who rated each of these concepts as either good or very good: the setting, 95.7%; cutaneous protection, 94.7%; the filter's functioning, 93%; the shape of the bag, 95.7%; the quality of the soft covering, 98.4%; and overall rating, 97.3%. 96.8% of the professionals involved in this study stated they would recommend this product in the future. COMMENTS: The results of this study confirm the effectiveness of Alterna Ideal as a collecting device for persons who have undergone a colostomy. This product is a highly valuable therapeutic alternative which can aid this group of patients to enjoy an improved quality of life.

Colostomy↗
PubMed2000

Chest wall peritoneal dialysis catheter placement in infants with a colostomy.

The presence of a colostomy in infants with end-stage renal disease (ESRD) receiving peritoneal dialysis (PD) is associated with an inherent risk for contamination and the development of a PD catheter-associated infection. A two-piece presternal catheter designed to reduce the incidence of such infections has been used in a small number of children, but the implantation of the catheter is technically difficult, and there is a risk of disconnection of the two parts secondary to rapid patient growth in the first year of life. Alternatively, a conventional Swan neck catheter, larger than typically required, can be placed with its exit site located on the chest wall. Over the past three years, we adopted this novel approach in two patients with ESRD and a colostomy in whom PD catheters were placed at ages 4 days and 12 days, respectively. During a combined follow-up of 50 months, only one episode of peritonitis and no episodes of exit-site or tunnel infection have been observed. This experience supports the use of this unique approach to PD catheter placement in infants with ESRD and a colostomy.

Abnormalities, Multiple↗
PubMed2001

Diverting loop colostomy for the treatment of refractory gastrointestinal bleeding secondary to radiation proctitis.

Chronic radiation proctitis is an uncommon and serious complication of radiotherapy for pelvic malignancies. It has been suggested that fecal stream diversion decreases bowel irritation, resulting in decreased rectal bleeding. We report on the outcome of patients after a diverting loop colostomy for the treatment of severe radiation proctitis. All consecutive patients with chronic proctitis treated with diverting loop colostomy for bleeding at one institution between October 1991 and June 1999 were studied. Four patients presented with rectal bleeding and diarrhea, and two patients had only bleeding. The mean dose of radiation received was 6,115.11 +/- 955.11 rad. Symptoms of chronic proctitis appeared at varying intervals of time after radiation, ranging from 14 months to 17 years. There were no operative complications. During follow-up (36 +/- 29 months), only one of nine patient continued to bleed. Four patients died during the study (cancer relapse, two patients; heart failure, one patient; one death was caused by severe radiation proctitis). Diverting sigmoid loop colostomy, when performed in properly selected patients with severe bleeding secondary to radiation proctitis refractory to medical management, is well tolerated and effective.

Aged↗
PubMed2002

[The role of continent perineal colostomy in surgical emergencies of the distal bowel].

Diverting colostomy is commonly required in surgical emergencies of the distal colon, especially if the patient is in poor condition. This paper shows that the colostomy could be unnecessary in most cases. In the last 10 years, 6 patients (4 with high-risk or postoperative complicated Hirschsprung disease, 1 with intestinal neuronal dysplasia and 1 with iatrogenic rectal stenosis obstruction) have been submitted to primary continent perineal colostomy-modified Duhamel's procedure. The modified technique consists of the exteriorization of the normal colon or ileum by a retrorectal and trans-anal way, while the excision of redundant tissue and rectal spur section are postponed at least for 10 days. In personal experience this peculiar surgical approach allows to avoid not only the complications due to the fashioning of a contraindicated primary anastomosis, but even those due to stomy performance and its closure, promoting good anatomo-functional results in all patients. The advantages of modified Duhamel's operation compared to other procedures (Swenson-Pellerin or Soave pull-through) depend on the rapidity of execution and on the quality of short and long term outcome.

Adolescent↗
PubMed2001

[Pseudocontinent colostomy - a manometric study].

The intraluminal pressure in terminal segment of colon has been studied at 42 patients undergone an exterpation of rectum and taken out pseudocontinent colostomy onto a front part of the abdomen. Schmidt's pattern smooth muscle muff, modified in the Clinic Surgery and Coloproctology at MU--Varna, has been transplanted around the colon, taken out as continent colostomy. The intraluminal pressure in the terminal segment of colon has been identified with an index of resistance on the side the smooth muscle muff against the spontaneous evacuation of the colon content. The pressure has been registrated at rest and after the mechanical dillatation of muscle muff. The pressure at the check group of 20 patients with taken out continent colostomy has been investigated manometrically. The basal intraluminal pressure at the patients with a transplanted smooth muscle muff has been 30 +/- 2.9 mmHg at the end of the first postoperative month, as it has been sustained permanent (29.7 +/- 3.0 mmHg) up to the second postoperative jear (0.001). The pressure has been increased up to the mean value of 42 +/- 2.5 mmHg, as it has been sustained at this level for a period of 120 sec. The basal intraluminal pressure at the patients with transplanted smooth muscle muff has been more then four times higher in comparison with the pressure in c. sigmoideum, which has been a prerequisite for stopping of the spontaneous evacuation. A conclusion has been done that the index of resistance in the terminal segment of colon has been depended on a functional potential of the smooth muscle muff directly. The transplanted muff has been an anatomic structure manifested a functional activity in terms of isolation.

Adult↗
PubMed2002

[Surgical creation of a reservoir-colostomy with reflex evacuation].

The authors consider that the problem of social rehabilitation of "colostomized" patients consists in an involuntary and sudden character of evacuation from the ostomy due to the absence of normal imperative urge to defecation. For this purpose a method of reservoir-retaining colostomy modulating the appearance of urge to defecation was worked out in experiments and used in clinic in 17 patients. Preconditions for the appearance of the urge were regular sensations due to mediated distention of the parietal peritoneum after filling the reservoir-retaining volume. The subjective sensations preceding the evacuation from the colostomy appeared 10-20 minutes before defecation and were felt as discomfort and abdominal cramping towards of the external end of the colostomy in 15 (88.2%) and as elements of intestinal colic in 2 (11.8%) patients. So, 9 (53%) patients managed to sufficiently control the evacuation from the ostomy and not to use the pouch. Five patients (29.4%) demonstrated the ability to restrain defecation for 10-15 minutes by straining the anterior abdominal wall muscles when the urge appeared. Evacuation from the ostomy was reiterative (2-4 times), once or twice a day, rarely 3-4 times a day and lasted from 15 till 60 minutes.

Colostomy↗
PubMed2002

[Usefulness of endosonography in patients with colostomy before decision of decolostomy].

The aim of this study was to visualize the suspected defects of the anal sphincters in patients following colostomy by anal ultrasound (AUS) and to analyze possible factors that could have led to such defects. For AUS, Bruel & Kjaer scanner with 7.0 MHz endorectal probe was used in a group of 30 patients with a colostomy. Anal sphincters defects were qualified and quantified. For statistical analysis the ANOVA (Analysis of Variance) was used. Internal anal sphincter (IAS) was thin in all but three patients (27 patients; 90%) with the mean thickness 1.64 mm. A circular reduction of the thickness was seen in 23 patients (85.18%) and along the entire length of the IAS in 20 patients (74.07%). Echogenicity of the IAS was increased in 18 patients (60%) and in 13 of them (72.22%) this defect embraced the whole length and circumference of the IAS. The margins of the IAS were not well-defined in 11 patients (36.66%). A significant correlation was found between duration of the stomy and the IAS echogenicity defect (p-value = 0.0001). Endosonography of the anal sphincter may play an important role before a decision of decolostomy after Hartmann's operation or closing a loop colostomy.

Aged↗
PubMed2003

[Comparison of primary colonic anastomosis and colostomy in experimental localized fecal peritonitis].

BACKGROUND: To investigate the appropriate surgical method that should be selected in the localized fecal peritonitis due to colonic injuries with 24 hours delay. METHODS: Colonic injuries were performed in 35 rats and the repairs were carried out after 24 hours. Seven rats (%20) died of generalized peritonitis in this period. The remaining 28 rats in which fecal peritonitis were localized by surrounding organs, were randomized in two groups: colostomy (n=14) and primary anastomosis (n=14). Intraabdominal complications and 15 days mortality were assessed. RESULTS: The groups had similar results according to intraabdominal complications. The 15 days survival was 71.4 % for the colostomy group and 78.5 % for the anastomosis group (p=0.31) CONCLUSION: If the injured or perforated colon is surrounded by the organs and so the generalized peritonitis is avoided, primary anastomosis would have similar results with colostomy despite fecal contamination and prolonged intervention time.

Anastomosis, Surgical↗
PubMedDate not supplied

[Irrigation in colostomies].

The degree of acceptation of irrigation from a colostomy varies ostensibly from some cases to others, therefore, we study what occurs in our medium, separating those patients which have previously undergone other procedures (Group A) from those patients who have been informed and trained about the immediate postoperative period (Group B). GROUP A: 48 patients, 22 or 46% of these patients were considered not apt for irrigation. Of the 26 to whom this procedure was proposed, 14 or 54% accepted. Of these, 5 or 36% abandoned its use while 9 continued its use; this is 64% of those who accepted this procedure, 35% of those to whom it was proposed and 19% of the total study group. GROUP B: 189 patients. This procedure was not recommended to 95 patients, 50%. Of the 94 patients to whom this procedure was proposed, 65 or 69% accepted. Of these, 22 or 34% abandoned its use while 43 continued its use; this is 66% of those; who accepted this procedure, 46% of those to whom it was proposed and 23% of the total study group. CONCLUSIONS: In our medium, the practice of irrigation oscillates between 19 and 23% of patients who have undergone a colostomy, without any significant difference referring to the moment when a patient started this procedure. A first report on this study was submitted in the III National Congress for Nursing in Colostomies.

Adult↗
PubMed2004

[Affecting factors of quality of life of colostomy patients].

BACKGROUND & OBJECTIVE: This study was to identify the factors that affect the quality of life (QOL) and bring forward methods of improving the QOL of colostomy patients, so as to offer evidences for practical nurses. METHODS: A descriptive, correlative design was employed in this study. From October, 2002 to February, 2004, 86 colostomy patients who discharged from Tumor Hospital of Sun Yat-sen University were recruited to complete a series of questionnaires, including EORTC QLQ-C30, Symptom Check List(SCL-90), Perceived Social Support Scale(PSSS). The SPSS11.0 was used for data analysis. RESULTS: The QOL of colostomy patients was relatively low. The mean score of EORTC QLQ-C30 was 49.13+/-17.20. The score of QOL was negatively correlated with the score of SCL-90 and positively correlated with the score of social support. The score of SCL-90 was the most important factor that affected the QOL, followed by the income of the patients. CONCLUSION: The major factors affecting the QOL were mental health status, financial status and social support of the patients. The results point out practical nurses should keep an eye on these factors.

Adult↗
PubMed1992

[Subtotal colectomy in splenic flexure carcinoma in a patient with transverse colostomy who had undergone gastric resection (Billroth II)].

The Authors report a case of subtotal colectomy for splenic flexure adenocarcinoma in a gastro-resected patient bearing a transverse colostomy. They underline the considerable technical difficulties encountered during dissection because of multiple adhesions related to the previous operations (gastrojejunostomy and transverse colostomy). In fact, a gastric resection according to Billroth II and an emergency colostomy for bowel obstruction had been performed 20 years and 30 days respectively prior to the present operation. Nevertheless, reconstructive steps resulted easier and faster with the use of staplers.

Adenocarcinoma↗
PubMed1991

[Primary adenocarcinoma at a colostomy site].

The colostomy opening is a very rare site of the large bowel cancer. There is only one case report in the world literature and none in the Hungarian one. The authors report a case of a 51 year old man, who presented a typical malignant growth in his colostomy opening, created 24 years before due to a rectal lesion considered as an inoperable cancer, though not proved histologically. Later the patient was treated by telecobalt irradiation, and the growth perfectly disappeared. Now the second, metachron malignancy arising from the colostomy has been removed and the patient is symptom free four years after the operation. Emphasizing the importance of postoperative follow-up in cases of gastrointestinal malignancies the authors considered this case as an unique but instructive one.

Adenocarcinoma↗
PubMed1991

[The removal of colostomies in patients with cancer of the large intestine].

Issues involved in closure of double-barreled and lateral colostomies in patients with cancer of the large bowel were analysed to find out whether the latter disease is a risk factor in reconstructive surgery. The analysis included 215 patients. In 77 (35.8%) of them, colostomy was formed in the course of treatment for large bowel cancer. Two groups of patients were compared by some parameters of patient's preoperative condition, time of closure, method of preparation and type of surgery. Comparison of early postoperative complications following closure revealed significant difference in the frequency of complications on the part of anastomosis. The latter were observed in 11 (14.3 +/- 3.9%) patients with large bowel cancer and 6 (4.4 +/- 1.7%) cases of nontumor pathology (P = 0.023). The rate of development of those complications was shown to depend on the method used to restore the continuity of the bowel. It was concluded that cancer of the large bowel was not a direct factor of risk in closure of double-barreled and lateral colostomies.

Anastomosis, Surgical↗
PubMed1990

[Experiences with a subcutaneous, fully resorbable bridge in construction a double loop ileo- and colostomy].

Our experience with the subcutaneous absorbable bridge for constructing a temporary loop ileostomy and loop colostomy is described. The use of this subcutaneous absorbable bridge in 15 patients - 6 with loop ileostomy and 9 with loop colostomy - was almost without complications. The absorbable bridge is a progress for maturation of the stoma and for immediate postoperative as prospective fitting of a watertight appliance. The actual trend substituting the temporary loop colostomy by the loop ileostomy may be advanced by the unlimited use of the subcutaneous absorbable bridge for constructing a temporary loop ileostomy.

Adult↗
PubMed1990

Endoscopic examination of the colon and rectum distal to a colostomy.

We report results of the endoscopic examination of the colon distal to a colostomy in 85 patients. Almost half had symptoms related to the excluded bowel. Whereas severe colitis or tumor may be asymptomatic, many patients had discomfort, pain, bleeding, and discharge. Endoscopic examination revealed abnormal findings in 80% of the patients. These were as uncomplicated as mucous plugs or as serious as polyps or carcinoma. We found a high incidence of diversion colitis in the excluded colon. Because of these abnormal findings, endoscopy of the bowel distal to a colostomy at regular intervals is recommended. Mucous plugs and scybala should be treated by irrigation, while polyps and carcinoma should be treated as they would in the nondiverted colon. Diversion colitis can be treated medically with local steroids, or surgically. In most cases, even in severe colitis, we recommend closure of the colostomy. Removal of the excluded colon is seldom necessary.

Colonic Diseases↗
PubMed1978

Effect of colostomy on intestinal carcinogenesis by methylazoxymethanol acetate in rats.

The effect of the fecal stream on the induction of intestinal tumors was studied in 3 groups of SD rats. Rats in group 1 were subjected to single-barreled colostomies for the complete exclusion of the fecal stream at the proximal one-third level of the colons and were given consecutive iv injections of methylazoxymethanol acetate. Rats in group 2 were given methylazoxymethanol acetate alone. Rats in group 3 were not treated and served as controls. Tumors were noted in the small and large intestines of almost all rats in both groups 1 and 2. Even animals with single-barreled colostomies frequently developed tumors in the colon distal to the colostomy where the mucosa did not have contact with the fecal stream. These results indicated that carcinogens could probably reach the intestinal mucosa via the vascular system as well as by biliary transport.

Animals↗
PubMed1987

Graft reconstruction to treat disease of the abdominal aorta in patients with colostomies, ileostomies, and abdominal wall urinary stomata.

Abdominal aortic reconstruction combined with colon or urinary tract operations is generally not acceptable because of a supposed greater incidence of graft infection. Similar fears exist regarding aortic reconstruction in the presence of colostomies, ileostomies, and permanent urinary diversion stomata. In fact, the presence of a colostomy has been reported to be a contraindication for abdominal aortic reconstruction. This report is concerned with vascular operations in 13 such patients with aortic disease referred to us for fear of these complications. Eleven patients had abdominal aortic aneurysms and two had atherosclerotic occlusion of the aorta and iliac arteries. Twelve patients had colostomies, ileostomies, or both and one patient had permanent tube cystostomy. All had good renal function and the disease for which the diversion procedure was performed was either cured or under good control. All patients survived the vascular reconstructive procedures without significant complications and long-term follow-up revealed that late graft infection did not occur.

Abdominal Muscles↗