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The technique of purse-string closure of a mucous fistula to prevent faecal contamination during loop colostomy is described in six patients who underwent the procedure. Complete faecal diversion was achieved in all six patients without complications.
Immobilization and subsequent sacral decubitus or pressure sore formation is a danger faced by the paraplegic. We report on 4 patients treated with non-healing pressure sores. Three male patients had decubiti eroding into the posterior urethra and bladder neck area. One female patient had bladder neck and urethral loss secondary to Foley catheter erosion and a sacral pressure sore. All 4 had non-healing decubiti secondary to urinary contamination and, in addition, gross fecal contamination in the male patients. All patients failed previous muscular flaps and urinary diversion per suprapubic tube. In the male patients, suprapubic continent urinary diversion included bladder neck mobilization, closure of the distal urethra by oversewing and patching with bovine dura, and augmentation of the bladder with a Miami pouch. Fecal diversion was provided with a sigmoid colostomy. In the female patient, continent diversion was performed by forming a Miami pouch. Total diversion allowed healing of the pressure sores and provided a simpler method of personal hygiene. Details of the diversion and case studies will be presented.
A loop colostomy of the sigmoid colon was constructed in a 48-year-old woman because of stool incontinence owing to a severe sphincter lesion. The operation was performed by laparoscopy. A special 3.5 cm trocar was employed for bringing the sigmoid colon through the abdominal wall. This technique allows the surgeon to avoid a lower median laparotomy in selected cases, and allows discharge of the patient within a few days.
The role of laparoscopy in the management of trauma patients is evolving. We describe a case of a laparoscopically created colostomy for treatment of a gunshot wound to the rectum.
Recent interest in the role of the ceca in avian nutrition has focused on recycling of urinary nitrogen through the ceca. In the colostomized chicken, we observed appreciable decrease in utilization of dietary urea nitrogen. This is the first report demonstrating that the ceca are able to play an advantageous role in nitrogen nutrition of the chicken, because back-flow of urinary nitrogen into the ceca was completely inhibited by colostomy. When colostomized chickens were fed a diet containing urea, little urea was found in feces but the amount of urea excreted in the urine corresponded to 77.5% of urea intake. Droppings of normal control chickens fed the same diet did not contain urea. However, they contained twice as much ammonia as the urine plus feces of colostomized chickens, indicating active and great degradation of urinary urea to ammonia by microflora in the ceca of control chickens. The recycling of urinary nitrogen through the ceca may be involved in the utilization of dietary urea by the chicken.
Mucocele formation is a rare complication of colorectal surgery. We present a case of a mucocele following colostomy and mucosal proctectomy for fecal incontinence. The pathophysiologic and radiologic features are similar to those of mucocele of the appendix.
Surgical stapling instruments have been used successfully in gastrointestinal anastomosis. A surgical technique using the staples to close a loop colostomy in gynecologic oncology patients is presented. The procedure shortens operating time and results in an enlarged anastomotic site, thus minimizing the possibility of obstruction at the site.
During the past 24 months I have used a defined formula diet (High Nitrogen Vivonex) as a nutritionally complete "medical colostomy" (NCMC) in 16 patients. This diet, via continual gastric drip, provided an average of 2,238 kcal/day and 92.4 gm of protein per day. Separately or in combination, loperamide HCl, diphenoxylate HCl, or codeine was used to slow the bowel. No patient had a bowel movement within less than three days postoperatively and the mean between bowel movements was 5.6 days. Defined formula diet, used as an NCMC, can give 2.4 times more kcal than clear liquid and provides protein as well. NCMC is a safe, cost-effective way of preventing fecal contamination while providing adequate nutritional support for wound healing.
Two hundred and fifteen colostomy patients were interviewed at 10 weeks after surgery from a stratified random sample of 12 health districts in which stoma-care nurses were employed and eight other districts: 85 survivors who did not have restorative surgery were reinterviewed 1 year later. The Present State Examination (PSE) was used to assess the prevalence of affective disorder on both occasions. Analysis of covariance of the 10-week PSE scores revealed that age was unrelated to psychological adjustment after controlling for the extent and severity of patients' symptoms and that patients in districts which employed stoma-care nurses had significantly lower PSE scores. Single and widowed males appeared to enjoy better emotional health than married men and than women. Analysis of covariance of PSE scores obtained 1 year later also revealed that age was unrelated to psychological adjustment after controlling for the patients' physical state. No difference was found between patients who had access to a National Health Service stoma-care nurse and patients in other districts, many of whom had seen a representative from one of the appliance companies. The finding that single and widowed males appeared to fare better than married men was repeated. Ten per cent of patients who felt completely well were anxious or depressed. Psychiatric referral may be inappropriate for the majority of depressed patients who may instead benefit from medical treatment or from nursing intervention to deal with physical symptoms such as pain or urinary incontinence.
A personal retrospective series of 100 consecutive colostomy closures performed between 1968 and 1978 is reviewed. Serious intraabdominal complications occurred in three patients. The total complication rate in this series was 29%. There were no deaths and no faecal fistulae. However, wound infection occurred in 22 patients.
A technique for closure of double-barrel colostomies using the GIA and TA 90 stapling instruments is described. The method is straight forward and time saving, and represents a further application of automatic staplers to gastro-intestinal surgery.
Diversion of the faecal stream by ileostomy or colostomy leads to inflammation in the defunctioned segment, known as diversion colitis. The affected bowel is rapidly restored to normality by reanastomosis. Diversion colitis should not be mistaken for inflammatory bowel disease, for which reanastomosis would be inappropriate. Studies of biopsy material from patients with diversion colitis have shown a variety of histological features, but no consistent pattern. The histology in resection specimens of defunctioned large bowel from 15 patients with no pre-existing inflammatory bowel disease was studied. Nine patients had symptoms of abdominal pain or rectal discharge of blood or mucus that developed between 9 months and 17 years after diversion procedure. The histology was abnormal in all. Findings were similar in 14 patients, regardless of the duration of faecal diversion, and comprised diffuse mild chronic inflammation with or without mild crypt architectural abnormalities, crypt abscesses, or follicular lymphoid hyperplasia. One patient had more severe changes, resembling active ulcerative colitis. These features in biopsy specimens are unlikely to be diagnostic but should provide useful information in avoiding a mistaken diagnosis of inflammatory bowel disease in these patients.
The authors developed a colostomy appliance for use during barium-enema examinations. It is 8 cm in diameter and 4 cm in height, and is made of acrylic resins. With the use of this device, 21 patients were fluoroscopically examined through the stoma; good contrast views of the lower intestinal tract were obtained in all cases without leakage of barium or air.
A simple technique of intraoperative decompression and colostomy in neonates with a massively distended abdomen is described. With this technique, the handling of distended bowel becomes easier and peritoneal contamination by meconeum is also prevented.
This article gives the reader an overview of recent developments in appliances for people with a colostomy. After a brief background, the various products that have been brought onto the market in recent years are discussed.
This case study describes the physical, psychological and emotional problems of a female patient suffering from rectal cancer, who required the formation of a colostomy. It highlights the role of the stoma care nurse from diagnosis, though staging of the disease, to treatment and recovery in hospital and at home, and discusses the problems of altered body image and the need for effective communication to enable the patient to achieve a good quality of life.
This article presents some of the findings from a multicentre cross-sectional correlational study to evaluate the relationship between colostomy pouch change and disposal practices and the patient's psychological wellbeing. Five questionnaires were used in a one-off interview with 86 patients. Patients were assessed at between one and four months postoperatively. Results from the Pouch Change and Disposal questionnaire showed that only 25% of patients found disposal of used appliances the most difficult part of their pouch change and disposal routine. Half felt that their body was out of their control and 33% reported avoiding social and leisure activities due to what was involved in their pouch change and disposal routine. Patients cited several factors, such as minimizing odour and having an appliance that could flush away, as factors which would help them to stop avoiding these activities. Stoma care nurses have a unique opportunity to improve the psychological wellbeing of their patients by considering the aspects of pouch change and disposal that pose the greatest challenge to individuals. Use of a modified version of the Pouch Change and Disposal questionnaire may be a useful tool in identifying those at risk of impaired quality of life.
A readily feasible technique for producing an excellent air contrast examination of the colon in patients with colostomies is described. The technique employes no special equipment and is easily tolerated by patients. Indications for the examination include a symptomatic patient with a negative conventional enema or suspicious single column examination. The surprisingly high incidence of both benign and malignant coexisting colonic neoplasms is reviewed.