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A case of thermal burn and stricture of the colon following colostomy irrigation with hot water is described. The initial radiographic features on barium enema simulated nonspecific segmental colitis. Colonic stricture and enterolith formation developed subsequently. This case emphasizes that care should be taken in preparing irrigating and barium enema solutions.
An easy and simple method for constructing a urinary diversion in patients undergoing pelvic exenteration for advanced rectal cancer is described. This procedure features double-barreled colostomy with a segment of the sigmoid colon 8 to 10 cm distal to the stoma as a urinary conduit.
Loop transverse colostomy is a procedure that has been traditionally employed on a temporary basis for a number of indications, but, with improvement of intestinal suturing and stapling techniques, the applicability of this modality has become quite limited. This paper addresses the issue of securing the loop and traces the history of the development of this method to decompress the bowel, to divert the fecal stream, and to defunctionalize the distal colon.
A simple maneuver that avoids soiling of the field during immediate maturation of colostomy performed for large bowel obstruction is presented. This maneuver involves inflating a large Foley catheter in the lumen of the obstructed large bowel just before maturation is performed.
PURPOSE: This study was designed to evaluate the long-term complication rate of left iliac fossa end sigmoid colostomies and to determine etiologic factors. METHODS: A retrospective chart review and actuarial analysis were performed. RESULTS: The crude and actuarial risks of paracolostomy complications in 203 patients were 51.2 percent and 58.1 percent at 13 years, respectively. Paracolostomy hernia was the most common complication (36.7 percent at 10 years). Siting the stoma through the belly of the rectus abdominis muscle did not reduce the risk of hernia, but an extraperitoneal course had a significantly lower risk of herniation when compared with a transperitoneal course and intestinal obstruction was marginally less frequent. Paracolostomy hernias were otherwise more likely in the elderly, and in those with other abdominal wall hernias. Mesenteric fixation did not reduce the subsequent chance of prolapse. The reduction in the risk of intestinal obstruction when lateral space closure was employed was not statistically significant (4 percent vs. 10 percent, P < 0.1), and all three patients with stomal retraction had had lateral space closure. CONCLUSION: The evidence in this study that spans a 22-year period questions much surgical technical dogma and raises the possibility that parastomal hernias may, like inguinal hernias, represent a failure in the transversalis fascia that might technically be avoidable.
Inflammatory fibroid polyps (IFPs) are rarely found in the gastrointestinal tract. The majority of IFPs are sessile-pedunculated or pedunculated polypoid lesions, whereas a polyp presenting like a Borrmann type II lesion is extremely unusual. This report describes the case of a 74-year-old man with a history of intussusception, in whom a preoperative diagnosis of a cecal tumor of the ileocecal valve was made. A laparotomy subsequently revealed a lesion similar to a Borrmann type II tumor located 15 cm above the ileocecal valve, but not at the valve. The lesion was diagnosed as an IFP which had been caused by repeated colostomy irrigation. The aim of the present report is to draw attention to this entity, which should be included in the differential diagnosis of intussusception and small bowel obstruction.
A simple technique for performing a functional end sigmoid colostomy is reported. This procedure can help to prevent retraction of an end stoma in an obese patient or any patient with a shortened mesentery.
A simple device, applied to a conventional stomal appliance, prevents loop colostomy prolapse.
Primary adenocarcinoma arising at a colostomy or ileostomy site is very rare, and only three cases have been reported following surgical treatment of ulcerative colitis. A 38-year-old man who developed an adenocarcinoma originating at the site of a colonic stoma and producing a large fungating tumor mass in the surrounding abdominal wall is described. This occurred 19 years after Miles' operation for a carcinoma of the rectum.
A technique for constructing a permanent transverse loop colostomy that permits distal decompression without risk of distal limb prolapse is described.
A case of burn and stricture of the ostomy subsequent to colostomy irrigation is reported. Heretofore, perforation has been the only serious complication noted. In this case, it was necessary to reconstruct the ostomy because of the development of postburn stricture.
A method of loop colostomy and ileostomy construction is described. The stoma provides complete diversion and can be either temporary or permanent.
Biofeedback training is proposed as rehabilitative training for patients with permanent colostomies to help them achieve fecal continence. The results of a preliminary study of 18 patients are reported.
A method is described in which a simple disposable plastic umbilical cord clamp replaces the traditional cumbersome instrument or expensive staples in the operation of end colostomy.
The temporary skin-level loop transverse colostomy has been described. Proof of its ability to divert the fecal stream totally is illustrated by complete diversion in 25 patients ingesting a postcolostomy barium meal. There was no postoperative complication.
A unique case of submucosal mucus-containing cysts of the colon occurring at a colostomy site is described. The cysts appear to have been the result of surgery eight years previously, and were due to either implantation of colonic mucosa into the submucosa or entrapment of mucosa following healing of postsurgical ulceration. Because these cysts are identical to the lesions seen in colitis cystica profunda, this case provides additional support for the hypothesis that colitis cystica profunda is an acquired disease, and illustrates that it may occur as a rare complication of colonic surgery.
The indications, operative procedure, postoperative complications and advantages of laparoscopic ileostomy and colostomy as compared with "open" enterostomy are described and demonstrated in our own patients with Crohn's disease. Major indications for laparoscopic enterostomy in patients with Crohn's disease are stenosis, fecal incontinence and complex anal fistulas in those with severe Crohn's proctitis. Most Crohn patients tolerate laparoscopic enterostomy and an increasing number demand this minimally invasive technique. The period of convalescence is much shorter and complications in connection with laparotomy are minimized.
A transverse loop colostomy to protect a low colorectal anastomosis should be carried out with minimal morbidity and mortality related to its creation and closure. A modification of the conventional technique is described.