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PubMed1992

[Effect of cecostomy on the pathophysiology and prognosis of acute experimental pancreatitis].

In 76 male wistar rats with a median weight of 340 g acute pancreatitis was induced by injection of 2% sodium taurocholate into a temporarily closed duodenal loop. 40 animals received an additional cecostomy (group B), the others served as controls (group A). The postoperative figures for amylase, leucocyte count, and hemoglobin were nearly identical in both groups. According to histologic criteria acute pancreatitis was comparable in both groups, too. In nine rats endotoxin was found elevated postoperatively (13.4%). Seven animals belonged to the control (22.6%) and only two to the cecostomy group (5.6%). The difference was statistically significant (p less than 0.05). Also the differences between the median serum endotoxin levels reached statistic significance (79 ng/l in group B vs. 219 ng/l in group A). Mortality was significantly increased in endotoxin-positive animals (42.9% vs. 19.4%). Additionally, among the animals of the control group alterations of the colonic mucosa were observed more frequently than in the cecostomy group. The results are in favour of a translocation of endotoxin from the gut lumen into the circulation during acute experimental pancreatitis.

Acute Disease↗
PubMed1987

Cecostomy revisited. Still a useful operation.

The necessity of a cecostomy in the management of large-bowel obstruction continues to be debated. Recent reviews have tended to discredit or disregard this therapeutic method in favor of the colostomy. Past criticism has focused on three central issues. First, local stomal care is difficult. Second, satisfactory bowel preparation cannot be accomplished. Third, a high incidence of surgical closure of the cecostomy is reported. In light of this continuous controversy, a retrospective review of tube cecostomies was conducted to assess the indications, morbidity, and success or failure associated with this treatment modality.

Adult↗
PubMed1997

The cecostomy button.

Percutaneous insertion of a cecostomy tube, performed under local anesthesia, to facilitate antegrade colonic cleansing, has been an invaluable advance in the management of fecal incontinence. However, the patient is left with a length of tubing (2 to 4 inches) protruding from the cecostomy site that has to be taped down to the abdominal wall. Available devices for insertion in place of the cecostomy tube are cumbersome and have a relatively high profile, projecting more than 1 cm from the surface of the abdominal wall. Worn under a swimsuit, they are clearly discernible. The inflated balloon within the cecum can occasionally break. Furthermore, in the individual with a relatively thick abdominal wall, such devices are too short to reach from the skin to the cecum. A new form of low-profile trapdoor device has been developed that overcomes the above shortcomings of other available "buttons." It has been successfully used in a clinical setting in 49 patients.

Catheters, Indwelling↗
PubMed1997

Fecal incontinence in children: treatment with percutaneous cecostomy tube placement--a prospective study.

PURPOSE: To evaluate the technique used for and long-term results of percutaneous cecostomy tube placement for the treatment of fecal incontinence in children. MATERIALS AND METHODS: After an initial pilot study in 15 patients, 42 additional patients with fecal incontinence aged 2-20 (mean, 11.5) years and weighing 9.9-109.0 (mean, 39.2) kg underwent percutaneous cecostomy tube placement. Twenty-nine patients had spina bifida, nine had imperforate anus, three had cloacal anomalies, and one had Hirschsprung disease. Mean follow-up was 265 days (range, 8-503 days). RESULTS: Tube placement was successful in all patients. One patient developed local inflammation after accidental early retention-suture removal, which was treated with suture replacement and intravenous antibiotics. Another developed postprocedural ileus, which resolved. Late complications included constipation in one patient (treated with diet alteration), granulation tissue in seven patients (treated with silver nitrate cautery), and accidentally dislodged tubes in three patients (two successfully replaced at home and one replaced at the radiology suite). Vomiting related to the phosphate enema occurred in two patients. Resolution of soiling was achieved in all patients. CONCLUSION: Percutaneous cecostomy and antegrade enemas are very successful in achieving fecal continence and patient independence and acceptability, with minimal early and late complications.

Adolescent↗
PubMed2002

[Survey on satisfaction of patients with Malone continent cecostomy].

OBJECTIVE: A questionnaire to assess their level of satisfaction was sent to 28 patients who underwent a continent cecostomy for antegrade enema (Malone procedure). MATERIAL AND METHOD: All the patients presented with neurogenic bladder and a severe constipation due to spina bifida in 21 cases, anorectal malformation in 4, cloacal malformation in 1, sacral agenesis in 1 and post-myelitis paraplegia in 1. The mean age at surgery was 15 years. The mean follow-up is 3 years and 8 months. Surgery on the bladder was done in 18 patients of which 10 at the same stage. Urinary continence between bladder catheterizations occurred in 5 patients with isolated cecostomy. RESULTS: 24 patients answered the questionnaire. Among the remaining 4, 1 has a too short follow-up, 1 refused the enemas and his cecostomy definitely closed and 2, when seen at clinics, have an excellent result. Enemas are done twice a week, they last on average one hour with an average of 3 litres of liquid, usually tap water. All the 24 patients consider to have benefited from the operation mainly regarding their personal, family and social wellbeing. All have acquired anal continence, only 3 have some soiling between enemas. The main reported drawbacks concern pain at passing of stools (14 cases) well improved by addition of Colopeg in the enema, fatigue (21 cases) or headache (5 cases) after enemas. These troubles, probably due to a temporary hyponatremia, are well improved by addition of table salt in the water. CONCLUSION: This enquiry established the high degree of satisfaction given by the Malone procedure in the treatment of severe constipation frequently associated with a congenital neurogenic bladder. Despite some drawbacks this solution must be considered in such situation.

Adolescent↗
PubMed1986

Percutaneous cecostomy for decompression of the massively distended cecum.

Massive dilatation of the cecum developed in an elderly man following admission for an acute episode of upper gastrointestinal hemorrhage complicated by myocardial infarction, ventricular fibrillation, and pulmonary edema. A diagnosis of pseudo-obstruction was made. After an unsuccessful attempt at colonoscopy, percutaneous cecostomy was performed under computed tomographic guidance, using trocar technique. The cecal distention resolved and did not recur. Percutaneous cecostomy is an alternative to colonoscopy and to surgical cecostomy in the treatment of massive cecal distention.

Aged↗
PubMed1986

Tube cecostomy revisited.

A retrospective review of 59 tube cecostomies, performed between 1971 and 1981, was undertaken to evaluate current operative indications, outcome and associated morbidity. Tube cecostomy was performed as a complementary procedure in 81.4% of cases; in the other 18.6%, it represented either the only operative intervention or the initial stage of a two-stage procedure. Complications included local infection in 32% of cases, peri-catheter leak in 25%, skin excoriation in 24% and pain in 12%. Catheters remained in place an average of 14 days, but function was adequate in only 40% of cases. Cecal drainage persisted from 24 hours to 90 days after the tube was removed. Two additional procedures were required to close persistent cecal fistulas. The authors conclude that the high morbidity associated with this procedure militates against its routine use. Decompression by cecostomy may be inadequate for treating acute colonic obstruction.

Adolescent↗
PubMed2006

Laparoscopic cecostomy button placement for the management of fecal incontinence in children with Hirschsprung's disease and anorectal anomalies.

BACKGROUND: Antegrade colonic enemas offer a surgical solution for many children with chronic constipation and encopresis associated with Hirschsprung's disease and anorectal malformations. This study demonstrated the feasibility of a new laparoscopic technique for cecostomy button placement (LCBP) to allow antegrade enema treatment. METHODS: Charts of children with encopresis who underwent LCBP between 1999 and 2001 were reviewed. The age, weight, primary diagnosis, operative time, hospital stay, associated complications, follow-up duration, and outcome of the patients were recorded. The surgical technique used a "U-stitch" method and a chait tube or a standard gastrostomy button. A follow-up telephone survey was conducted to assess parental satisfaction and overall success in continence. RESULTS: Seven patients ages 4 to 12 years (mean, 7.3 +/- 1.3 years) and weighing 15 to 44 kg (mean, 24.5 +/- 4 kg) underwent LCBP over a 2-year period. The mean follow-up period was 15 +/- 4 months (range, 6-33 months). Four patients had anorectal malformations, and three patients had Hirschsprung's disease. For all the patients, LCBP was accomplished without any intraoperative complications. The mean operative time was 33 +/- 2 min, and the hospital stay was 2 to 5 days (mean, 3.8 +/- 0.5 days). The patients received one or two daily antegrade enemas, and none had accidental bowel movements. Episodes of soiling at night once or twice a week were observed with two children. Two patients had hypertrophic granulation tissue formation, which responded to topical therapy. The button was uneventfully changed twice in one patient because of mechanical malfunction. CONCLUSION: To manage overflow incontinence of children with anorectal malformations and Hirschsprung's disease, LCBP is a technically straightforward, effective, and reversible method for the placement of a cecostomy button.

Anal Canal↗
PubMed1999

Percutaneous endoscopic cecostomy for antegrade colonic irrigation in fecally incontinent children.

The Malone surgical procedure for antegrade continence enema (ACE) greatly improves the quality of life of many patients with fecal incontinence but has several complications. This report describes a technique of percutaneous endoscopic cecostomy (PEC) which was applied in three children with fecal incontinence secondary to anorectal malformation or spina bifida. Using a pediatric fiberscope, a colonoscopy was done which reached the right colon. An intraoperative ultrasound examination confirmed the position of the cecum just below the layers of the abdominal wall. The cecostomy tube was then percutaneously inserted, imitating the steps of percutaneous endoscopic gastrostomy (PEG) using the pull technique. The preliminary results are very encouraging: there are no procedure-related complications in this small series; all the patients are able to carry out the antegrade enema by themselves; and complete control of defecation has been obtained.

Adolescent↗
PubMed1991

Tube cecostomy as a cause of cecal pseudotumor.

A 60-year-old male presented with findings on radiographic and physical examination which were compatible with colonic obstruction. A tube cecostomy was performed. Colonoscopy seven months later revealed a pseudotumor composed of granulation tissue in the cecum at the site of the previous cecostomy.

Cecal Diseases↗
PubMed1991

[The use of the TA-55 mechanical suturing device in the closure of the cecostomy. The authors' experience].

The authors confirm the actuality and validity of decompressive cecostomy in emergency treatment of large bowel obstructions. Taking into account that staplers have substantially reduced the rate of complications and inconvenient of gastrointestinal surgery, their use of cecostomy closure is proposed. Advantages obtained with this technique, namely lack of infections and incisional hernias, are underlined.

Acute Disease↗
PubMed1990

Complete extraperitoneal cecostomy. An ileo-colic diversion procedure after colonic operations.

A new external diversion technique of ileo-colonic content through an extraperitoneal cecostomy is presented. This technique avoids the draw back of the classical cecostomy: intraperitoneal leakage intestinal content, reoperation for closure the stoma. The procedure is simple, easily performed and efficient in protecting the colonic anastomosis, and diverting the ileo-colonic content.

Cecostomy↗
PubMed1997

Beclomethasone dipropionate administration via cecostomy in ulcerative colitis.

Beclomethasone dipropionate was administered via a cecostomy to four patients with active ulcerative colitis that was refractory to conventional glucocorticosteroid therapy. From a tube cecostomy, beclomethasone dipropionate solution was administered continuously throughout the day. Clinical manifestations, laboratory examinations, and endoscopic and/or radiographic findings markedly improved within 1-2 wk. A serial decrease in the index of disease activity was observed from the time administration began (mean score, 226.0) to 2 wk later (137.4 points). An excellent clinical response was recognized without any significant side effects, and the urgent need for total colectomy was avoided in all four patients.

Adult↗
PubMed1985

Continent cecostomy. An account of 30 patients.

In this paper, an account is given of our experience with continent colostomy in man. In five patients, the end-sigmoidostomy was provided with an intussusception valve. Evacuation of the bowel by irrigation through a catheter was laborious and time-consuming and this method was abandoned. In another group of 30 patients, the cecum was isolated from the rest of the colon and its distal end was provided with an intussusception valve. Of the 30 patients, eight were later given continent ileostomies, two were converted to conventional sigmoidostomies, and one patient with fecal incontinence preferred to have intestinal continuity reestablished. Thus, 19 patients still have continent cecostomies and are satisfied with their function. When comparing the function of the continent cecostomy with that of the continent ileostomy, however, it is obvious that the ileostomy function is superior. The experience obtained with this group of patients has resulted in a widening of the indications for constructing a continent ileostomy, including selected patients with various anorectal disorders.

Animals↗
PubMed1999

Colostomy vs tube cecostomy for protection of a low anastomosis in rectal cancer.

BACKGROUND: Symptomatic anastomotic leakage is the most important surgical complication following rectal resection with intestinal anastomosis. Therefore, the routine use of a protective stoma is suggested by several authors. In our department 2 different techniques are performed to protect the anastomosis. Patients receive either a loop colostomy/ileostomy (C/I) or a tube cecostomy (TC). HYPOTHESIS: No significant difference is noted between C/I and TC for protection of a low anastomosis regarding clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, and permanent colostomy rate. By avoiding a second operation (for colostomy closure), median hospital stay should be significantly reduced. DESIGN: A retrospective review during 1985 to 1997. SETTING: Tertiary care center PATIENTS: One hundred fifty-eight patients who had undergone anterior resections for rectal cancer were studied. Protective C/Is were used in 19 patients; a TC was fashioned in 30 patients. MAIN OUTCOME MEASURES: Clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, permanent colostomy rate, and median hospital stay. RESULTS: The rate of anastomotic leaks (C/I, 16%; TC, 17%), fecal peritonitis (C/I, 0%; TC, 10%), reoperation for anastomotic leaks/fistulas (C/I, 0%; TC, 13%), permanent colostomies (C/I, 0%; TC, 7%), and postoperative mortality (C/I, 5%; TC, 0%) did not differ significantly in both groups. Median hospital stay was significantly reduced in patients with TC (C/I, 28 days; TC, 15 days). CONCLUSION: In our patients with low resections for rectal cancer, a C/I for protection of the anastomosis did not improve outcome significantly as compared with a TC. With a properly fashioned TC and adequate postoperative management a second operation (for colostomy closure) can be avoided and the overall hospital stay is significantly reduced.

Aged↗
PubMed2004

Palliation of malignant bowel obstruction using a percutaneous cecostomy.

Bowel obstruction is a common complication of metastatic gastrointestinal and ovarian cancers, and can cause distressing symptoms. Along with medical options, surgical options should be considered in all patients with bowel obstruction, including percutaneous gastrostomy. We report the case of a patient with metastatic colon cancer with an obstructing recurrence at the primary site who was not eligible for major surgery or percutaneous gastrostomy and was managed with a percutaneous cecostomy for symptom control.

Adenocarcinoma↗
PubMed2002

Laparoscopic placement of the Chait cecostomy device via appendicostomy.

The authors describe their experience with a series of 11 patients in whom they have carried out Chait cecostomy catheter insertion into a laparoscopically formed appendicostomy. This technique has several advantages compared with percutaneous insertion and we now insert the device at the primary procedure. The authors have had one minor complication in their 11 patients, with mean follow-up of 8 months. This technique is recommended for the management of refractory constipation, for etiologies including spina bifida, anorectal malformation, distal intestinal obstruction syndrome, and slow-colonic transit.

Cecostomy↗