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At least 109 records · Page 6Linked to original sources
PubMed2006

Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructed sigmoid colon cancer: a case report.

Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.

Aged↗
PubMed1999

Stoma management in a tropical country: colostomy irrigation versus natural evacuation.

People with ostomies in Singapore were initially resistant to colostomy irrigation. This study, a prospective crossover study of 26 patients who underwent abdominoperineal resection, compared colostomy irrigation with the natural evacuation method. During the colostomy-irrigation phase of the study, all 26 patients reported an improvement in continence and fewer problems with sleep, sex, and skin complications compared to the natural-evacuation phase. The study also found a reduction in monthly expenses with colostomy irrigation compared to natural evacuation. Patient satisfaction scores were also superior during the colostomy-irrigation phase. This difference in satisfaction scores was less marked in those who were more than 1-year postsurgery than in those who were less than 1-year postsurgery. The difference in satisfaction between colostomy irrigation and natural evacuation scores was statistically significant in the group that was less than 1-year postsurgery, but not in the group that was more than 1-year postsurgery. The study concluded that colostomy irrigation after abdominoperineal resection is superior to natural evacuation in terms of cost and patient satisfaction and should be introduced soon after surgery.

Adult↗
PubMed2002

Colostomy in the newborn: technical pitfalls.

Colostomy is a commonly performed procedure in the neonatal period but the procedure is frequently underestimated. This report is aimed at raising awareness to technical errors made in performing the procedure. In a period of 4 years, 5 patients who had colostomy in the neonatal period developed problems, which were attributed to errors made in performing the procedure and have been retrospectively reviewed. In 3 patients, the sigmoid colon was erroneously used for transverse colostomy resulting in poor function. There was increased blood loss and increase in operation time from colostomy take down at subsequent definitive surgery in all 3. In one other patient, the ileum was mistaken for the transverse colon and opened, requiring closure; the closure leaked necessitating laparotomy, resection and anastomosis but death occurred from peritonitis. The fifth patient developed stoma necrosis due to ligation of the marginal artery and narrow fascial opening. Colostomy refashioning was necessary but death occurred from overwhelming infection. The colostomies were performed at a peripheral hospital and by unsupervised residents. Colostomy in the newborn can be associated with significant morbidity and mortality and great care is necessary to avoid these. Some technical points to avoid these errors are highlighted.

Anal Canal↗
PubMedDate not supplied

Colostomy complications in infants and children.

Seventy-seven colostomies were performed in 74 patients: 35 for high anorectal agenesis, 34 for Hirschsprung's disease, 2 for necrotizing enterocolitis, 2 for small left colon syndrome, and 1 for volvulus neonatorum with perforation. There were 55 boys and 19 girls with a mean age of 0.8 years. The different types of colostomies performed were: transverse loop in 48, sigmoid loop in 21, transverse end in 4, descending end in 2, sigmoid end in 1, and transverse double barrel in 1. Forty-seven patients developed stomal complications (74.6%). Eleven patients died, but only in 2 (2.7%) were the deaths directly related to colostomy formation. Five patients required stomal revision (6.8%). The incidence of complications was neither related to the age nor to the primary indication for the colostomy, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy (52% versus 81% 0.02 greater than p greater than 0.01). A sigmoid loop colostomy should be used whenever possible.

Child↗
PubMed2004

Colostomy type in anorectal malformations: 10-years experience.

AIM: The aim of this study was to evaluate the influence of colostomy type on morbidity during the treatment of anorectal malformations. METHODS: Sixty-eight infants (male: female ratio 1.3:1) with anorectal malformations that required colostomy were treated in our clinics during the period 1991-2001. Of these patients, 26 had received a loop colostomy: 14 of these underwent posterior sagittal anorectoplasty (PSARP) at the age of 9-12 months (Group A), and 12 underwent PSARP at the age of 2-4 months (Group B). Forty-two infants received a separated-stomas colostomy and underwent PSARP at the age of 9-12 months (Group C). The incidence of complications among groups was compared using the 2 sided Fisher's exact test. RESULTS: Eight cases from group A were complicated with prolapse of the stomas, perianal wound infection, pull-through dehiscence, and anal fibrotic stricture. The only complication observed in groups B and C was perianal wound infection, which occurred in 1 case from each group. A statistically significant difference was observed in the incidence of complication between groups A and C (p<0.001) and between groups A and B (p=0.014). The results from groups B and C did not differ significantly (p=0.398). When the cases complicated with colostomy prolapse were removed from the statistical analysis, groups A and C still differed significantly (p=0.001) but groups A and B did not (p=0.069). CONCLUSIONS: As the incidence of complications increases with time after a loop colostomy, we encourage either an early corrective procedure or the modification into separated-stomas colostomy (SSC) before PSARP is performed for those cases that would involve definitive surgery in late infancy.

Abnormalities, Multiple↗
PubMed1990

Achievement of stomal continence in one-third of colostomies by use of a new disposable plug.

A multicenter trial was established to assess the use of a new disposable colostomy plug in achieving stomal continence during four weeks in patients with established colostomies. Forty-six of the 100 patients evaluated completed the trial, of whom 41 stated that they would wish to use the system regularly. Twenty-nine of the 41 continue to use the plug daily since the trial finished. The remainder withdrew mainly during the early stages of the trial because of leakage (ten patients), discomfort (11) or difficulties (12), all largely related to extrusion of the plug from the colostomy. There were no discernible features to predict in whom the plug was beneficial. Patients who irrigated the colostomy retained the plug longer (16.5 hours), on average, than those with natural evacuation (8.5 hours). However, even in the latter, the time increased with use of the system (week 1, 7.5 hours; week 4, 9.8 hours). Longer periods of retention of the plug appeared to be associated with improved stomal continence. Results from this trial confirm the potential of the Conseal Colostomy System incorporating a disposable colostomy plug to restore continence and improve life-style in more than one-third of patients with colostomies.

Adult↗
PubMed1989

[Must we reject primary colostomy in left colonic obstruction caused by cancer?].

Treatment of left colonic cancer obstruction is not still clear. Many procedures can be done, simple decompressive colostomy by a local incisionnal way to subtotal colectomy with primary anastomosis. What can we do today? Retrospective study from 1983 to 1988 at Centre de Chirurgie Digestive de l'Hôpital Saint-Antoine (Paris) with 36 datas was done. The emergency treatment was 20 decompressive colostomies, 10 primary resections without anastomosis, 2 subtotal colectomies with ileo-sigmoid primary anastomosis, 2 left colectomies with primary anastomosis (2 with decompressive colostomy, one without) and one Hartmann procedure. One patient is dead after decompressive colostomy. After emergency decompressive colostomy, 16 patients (80%) were reoperated for colonic cancer resection, with suppression of the stomy fifteen times. There were 7 extra abdominal complications and 3 stomy complications (2 incisionnal hernias after closure of the stomy and one prolapse of a definitive colostomy). After emergency primary resection without anastomosis, 9 patients (90%) were reoperated for secondary anastomosis. Morbidity was 3 extra abdominal complications. The mean hospital stay was 28 days for these 2 groups. For all the patients with primary or secondary anastomosis there was no anastomotic leak. Decompressive colostomy as emergency procedure for left obstructing carcinoma is simple, efficiency and safe. It can be associated with low mortality and morbidity. To day, we still recommend this procedure.

Adenocarcinoma↗
PubMed1980

Colostomy closure following trauma.

All patients undergoing a post-traumatic colostomy closure at the New Jersey Medical School Affiliated Hospitals from 1974 to 1978 were studied for the effect of timing and technique of colostomy closure on postoperative complications. Analysis showed that patients in whom the colostomy was closed between six weeks and three months had a significantly shorter operating time when compared with those operated upon less than six weeks after formation of the colostomy. They also had a lower infection rate, shorter time to intestinal function and shorter postoperative hospital stay. Patients undergoing closure of a loop colostomy were analyzed for the technique of closure. Those patients undergoing a simple loop closure had a significantly shorter length of operation time, lower infection rate and shorter time to return of intestinal function. The safest time to close a colostomy created for trauma is between six weeks and three months. The reason for the increased complication rate in the early group is technical difficulty due to incomplete resolution of the edema and inflammatory reaction. Every effort should be made to close a loop colostomy without resorting to resection.

Abdominal Injuries↗
PubMed1995

Loop colostomy for treatment of grade-3 rectal tears in horses: seven cases (1983-1994)

OBJECTIVE: To determine the feasibility of performing a single-incision loop colostomy for treatment of grade-3 rectal tears in horses. DESIGN: Retrospective case series. ANIMALS: Seven adult horses with grade-3 rectal tears. PROCEDURE: A single-incision loop colostomy was performed with horses under general anesthesia (n = 6) or while restrained in standing stocks (n = 1). The rectal tear was lavaged via an endoscope. The colostomy was resected after the rectal tear healed. RESULTS: Rectal tears ranged from 4 to 10 cm in diameter and were > 25 cm proximal to the anus. All horses survived colostomy surgery. One horse was euthanatized at the request of the owner 1 day after surgery. Six horses underwent colostomy resection 13 to 30 days after colostomy. All horses had evidence of atrophy of the distal portion of the small colon, predisposing to impaction at the small colon anastomosis in 2 horses. One horse was euthanatized while hospitalized because of severe recurrent colic. Five horses were discharged from the hospital 31 to 45 days after admission. One horse was euthanatized 60 months after discharge from the hospital because of severe colic, and 4 horses were alive at the time of follow-up evaluation (3 to 12 months after discharge). CLINICAL IMPLICATIONS: The prognosis for horses with grade-3 rectal tears treated by colostomy appears to be favorable.

Animals↗
PubMed1995

[Quality of life of post-colostomy patients].

The psychosomatic care of patients after surgical treatment must comprise the analysis of quality of life with colostomy. Five different parameters were assessed of 100 colostomy patients. Sixty-one percent of our patients had skin irritation problems. Twenty-eight patients applied regular irrigation. Seventy-two percent of these had daily motions, 20% had bidaily, the remaining 8% had irregular bowel movements. Seventeen percent of the nonirrigating patients observed very irritating fecal discharge around the stoma. Embarrassing noises concomittant with bowel movements were observed by 42% and 45% struggled with bad odors. Irrigating patients had hardly any of these problems. For 65% of the patients the idea of having a colostoma meant the greatest psychological burden before the operation. The stress situation culminated in the immediate postoperative period in 10%. Forty percent of those asked were seriously worried about the reaction of their social environment. In 65% a significant decrease of social relations could be observed. Sixteen percent reported an increased social activity after colostomy had been performed. Sixty percent admitted considering the option of suicide at least once. Thirty-five percent revealed to have any kind of sexual problems after colostomy. Eight of our 100 colostomy patients experienced serious adverse reactions from their family members. In eighty percent of the cases family members showed great sympathy although they acted naively. The quality of life of colostomy patients may be best taken care of by qualified stomatherapists, out-patient proctology departments and the ileo-colostomy movement (ILCO).

Adult↗
PubMed1994

[Results of anal sphincteroplasty for post-traumatic incontinence: with or without colostomy].

Surgical repair of the anal sphincters after previous trauma is generally successful. In earlier publications, a protective colostomy was recommended but in most recent series colostomy is omitted. We have been through both phases and this is the first comparative study done on 82 consecutive repairs: 45 with colostomy from 1977 to 1986 (Group I) and 37 without colostomy from 1986 to 1992 (Group II). Causes of trauma were obstetrical: 50, surgical: 24 and violence: 5. Apart from colostomy related morbidity, postoperative complication rates were similar in the two groups. Results were graded excellent, good, fair or poor according to continence to solids, to liquids and soiling. Good and excellent results were obtained in 82% (Group I) and 87% (Group II) after a mean follow-up duration of 42 and 23 months respectively. Furthermore there was no difference between Group I and II in the rate of good/excellent results for cases who had undergone prior repairs (98% v. 100%) and also when the duration of incontinence was more than 10 years (71% v. 83%). We conclude that colostomy is not a determinant factor in the outcome and is therefore not required, avoiding all colostomy related morbidity and disability.

Anal Canal↗
PubMedDate not supplied

[Our technic for continent perineal colostomies after the abdominal-perineal amputation of the rectum].

Having briefly outlined the complex question of definitive abdominal colostomy, understood as an inevitable stage in demolitive anorectal surgery if the tumour is localised approximately 7-10 cm from the anus, the authors propose abdominal-perineal and perineal colostomy as logical alternative capable of offering a more satisfactory quality of life with equal oncological radicality. Currently used techniques are then discussed by which the perineal colostomy is fitted with a sphincter to make it continent. From this it emerges that the common limits to each method largely consist in the complexity of the operation and the type of postoperative care required, including a long period of postoperative stomal rehabilitation (with the relative equipment and staff) in order to achieve better functional results. Using their 10-year experience of perineal colostomies, also with sphincters, as a starting point, the authors illustrate their personal technique which ensures a degree of stomal continence which is comparable if not better than that obtained using other surgical procedures but is not so difficult to perform and does not require such full-time assistance. The consequent improved risk-benefit ratio for this type of operation means that the indications can be widened to coincide with those for traditional abdomino-perineal colostomy both with regard to age and the stage of disease. There are two basic steps in this technique. The first involves abdomino-peroneal demolition secondary to cancer and follows the conventional lines of classic abdomino-perineal colostomy; the second involves the sphincteric reconstruction which is performed using an extremely simple technique. The two small anti-mesenteric tenia of the prestomal colon are mobilised and placed around the colon so that they form a smooth double sphincter which completely occludes the former's lumen. On completing surgery, the sphincteric structure lies just above the perineal stoma whereas the underlying tract of colon, which is the site of the muscle graft, is completely extra-corporal until it has become regularized. The surgical safety of this technique is immediately evident from the fact that since it was introduced temporary abdominal colostomy has been no longer been performed, thus avoiding subsequent colorrhaphic surgery and reducing hospital stay, patient suffering and social costs.

Aged↗
PubMed1996

Colostomy complications in infants and children.

This study analyses the morbidity and mortality of colostomy formation and closure over a 17-year period during which 138 consecutive infants and children had a colostomy formed as the initial management of Hirschsprung's disease or anorectal malformation. Complications after colostomy formation were encountered in 38 (27.5%) patients and included colostomy prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. The complication rate with transverse colostomies was higher than with other types. Colostomy closure was associated with complications in nine patients (6.5%), the most serious of which was adhesive small bowel obstruction (5). The mortality was less than 1%, but significant morbidity still exists. Refinements in surgical technique may help reduce the incidence of complications, but stoma prolapse, particularly with transverse colostomies, remains a major challenge.

Anal Canal↗
PubMed1997

A randomised study of colostomies in low colorectal anastomoses.

OBJECTIVE: To assess the value of covering colostomy for patients undergoing low anterior resection for rectal neoplasms. DESIGN: Prospective randomised study. SETTING: Two university hospitals, Finland. SUBJECTS: 38 patients with air-tight stapled end-to-end anastomoses and complete anastomotic tissue rings were randomly allocated to have a covering colostomy (n = 19) or not. MAIN OUTCOME MEASURES: Postoperative mortality, anastomotic leaks, reoperations for leaks. RESULTS: The clinical leak rate was 24% (9/38) and six patients (16%) had radiological leaks. The total number of leaks (clinical and radiological together) was similar in the two groups, 7/19 compared with 8/19, respectively. There were fewer clinical leaks in the colostomy group (3/19; 16% compared with 6/19; 32%), but the difference was not significant. Reoperations for leaks were necessary more often in patients who did not have a covering colostomy (6/19; 32% compared with 1/19; 5%, p = 0.09). Two patients who did not have a stoma died from the infective complications of their leaks and one died of heart failure in the colostomy group. One patient who had not been given a stoma initially was left with a permanent colostomy after a leak. CONCLUSIONS: Our results suggest that a covering colostomy does not reduce the leak rate after low anterior resection, but prevents most of the severe infective consequences of the leaks.

Aged↗
PubMedDate not supplied

A case of obstructive colitis caused by possible colostomy dysfunction.

A case of obstructive colitis caused by possible stricture of colostomy is herein reported. A 58 year old female with an obstructive sigmoid colon cancer underwent an emergency descending decompression colostomy. At laparotomy, the colon proximal to the carcinoma was markedly distended and the bowel wall was thin, but the serosa appeared normal. Postoperatively, however, abdominal pain and distension persisted and low grade fever developed. Diarrhea through the colostomy continued. Nine days after the initial surgery, she underwent a left hemicolectomy. An abnormally thickened segment was identified in the resected specimen; normal mucosa was lost and several pseudopolyps were scattered. Histopathological findings of the abnormal segment were consistent with obstructive colitis. A preserved segment of normal mucosa intervened between the site of colostomy and the abnormal segment of obstructive colitis. A possible stenosis of the colostomy was considered to have caused colostomy dysfunction and subsequent obstructive colitis. She was complicated with anastomotic leakage due to the diseased colon being used for anastomosis. Obstructive colitis should be kept in mind in patients with obstructive colonic carcinomas who complain of persistent abdominal pain, distension and diarrhea in the early postoperative period after colostomy.

Colitis↗
PubMed2004

Seprafilm may ease colostomy reversal.

HYPOTHESIS: In this study, we aimed to investigate whether the use of a sodium hyaluronate and carboxy-methylcellulose-based antiadhesive membrane (Seprafilm, Adhesion Barrier; Genzyme Corp, Cambridge, Mass) is associated with fewer adhesions around the pelvis and rectal pouch. DESIGN, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Forty Wistar albino female rats were divided into 4 equal groups. Each rat underwent segmental left-sided colonic resection and end colostomy. The groups were as follows: group 1, colostomy alone (control group); group 2, colostomy and Seprafilm application around distal rectal pouch; group 3, colostomy and Seprafilm application beneath laparotomy incision; and group 4, colostomy and application of Seprafilm on both rectal pouch and laparotomy incision. All animals were operated on the 21st day and intra-abdominal adhesions were evaluated. RESULTS: The results were assessed by analysis of variance and Tukey multiple comparison tests. Intra-abdominal adhesions were significantly (P<.05) reduced in groups 2 through 4 compared with the control group, whereas no statistically significant difference was observed between these 3 groups. CONCLUSIONS: The use of Seprafilm during the initial step of the Hartmann colostomy reduced intra-abdominal adhesions on the reversal. This result might be beneficial in the prevention of adhesion-related difficulties during second operation and its application beneath laparotomy incision seems to be sufficient to ensure this effect.

Animals↗
PubMed1990

A retrospective study of colostomies, leaks and strictures after colorectal anastomosis.

A review was undertaken of 360 patients undergoing elective left-sided colonic or rectal resections with primary anastomosis, under the care of one surgeon, over a nineteen year period. The incidence, aetiology and management of anastomotic leaks and strictures was studied and the role of proximal diverting colostomy considered. Perioperative mortality was 2.7%. The incidence of anastomotic leaks was 24.4%. Leaks were more common when anastomoses were low, were sutured or were constructed by trainees. Strictures developed in 5.8%. Local recurrence of tumour was the cause of 25% of these strictures. Anastomotic leakage was the principal cause of benign strictures; those developing in association with leaks were more likely to require surgical intervention. There was no evidence that delay in colostomy closure contributed to the development of benign anastomotic strictures. It was not possible to determine whether the presence of a colostomy affected the incidence of leaks but the local effects of such leaks were mitigated in patients with colostomies. Where a minor leak had occurred it was not necessary to wait for complete anastomotic healing before closing the colostomy. After major leaks, colostomy closure before complete healing was associated with further anastomotic problems in 16.0% of cases.

Adult↗
PubMed1977

[Carcinoma of colostomies. Investigation on Wistar rats and clinical observations (author's transl)].

48 surviving male Wistar rats, which achieved a double loop colostomy at the descending colon, developed spontaneous adeno-cardinomas at the proximal orifice of the stoma within 120-200 days. To differentiate the importance of fecal passage and eversion of the colon, the descending colon was separated from the fecal stream by a colostomy at the ascending colon, splitted longitudinally and inserted in the abdominal wall. Adeno-carcinoma arose in both positions, mainly within 120 days. Colonic mucosa, thus exposed, predominates to maligne transformation. The preferred development of cancer at colostomies, as seen systemically induced colonic cancer, is therefore explained to be of syncarcinogenic type. Similar lesions were found at human colostomies. The rareness of original carcinoma at human colostomies is caused by a more-years time of induction in relation to the high average age of patients getting a colostomy. In fact we regard this type of cancer as a biological phenomena comparable to the cancer of the gastric stump.

Adenocarcinoma↗