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PubMed1980

[Cecostomy in the treatment of large intestine ileus].

Large bowel decompression by simple coecostomy is not generally accepted. As this procedure is our method of choice in all suitable cases, we have checked the results. From 1.11.1971 to 31.3.1979 a coecostomy was performed in 44 patients presenting with uncomplicated colonic obstruction. The operation was done through an ileocoecal muscle split incision without an exploratory laparotomy. The coecum was primarily opened and sutured to the skin. There were 38 carcinomas, one actinic sigmoid stenosis and one pancreatitic stenosis. In four cases further investigations did not show any mechanical bowel obstruction. In 37 patients there was a secondary laparotomy. In 34 patients the stenotic area was resectable. The coecostomy could be closed in 39 cases and was removed with the resected specimen in one case. Overall-lethality was 4/44, the lethality of mechanical large bowel obstruction was 4/40 or 10% respectively. Three patients died of metastatic carcinomas, one patient of thromboembolic complications. The coecostomy always was successful in decompressing the dilated bowel. The morbidity was negligible (one abscess after closure of the stoma with cicatricial herniation later on.

Adult↗
PubMed2002

Appendiceal versus ileal segment for antegrade continence enema.

PURPOSE: To assess outcomes after the antegrade continence enema procedure, we present our results with an ileal segment or the appendix in children with severe bowel dysfunction. MATERIALS AND METHODS: A retrospective review of 45 children who had undergone the creation of a continent cecostomy for severe chronic constipation and fecal incontinence was performed. RESULTS: The appendix was used to create the continent cecostomy in 28 patients (group 1) and ileum 17 (group 2). Of 16 patients who underwent simultaneous construction of appendiceal Mitrofanoff neourethra, including continent catheterizable stoma, the appendix was split and used for the cecostomy and neourethra in 11. Overall, acceptable continence was achieved in 39 (87%) patients and total continence 31 (69%). No significant difference was noted in the rate of continence between groups 1 and 2. Nonstomal postoperative complications occurred in 5 patients in group 1 and 3 group 2. Complications that required reoperation related to the continent cecostomy occurred in 10 patients, including stomal stenosis in 8, with 6 group 1 and 2 group 2 (p >0.05), and stricture in 2, with 1 group 1 and 1 group 2. There were 2 patients who had previously undergone colostomy for intractable constipation who were undiverted at the time of the creation of continent cecostomy. Both were continent postoperatively. There were 3 patients, including those 2 who presented with chronic severe constipation of unclear etiology, who underwent colostomy for unrecoverable colonic dys-motility, of whom 1 subsequently required total colectomy. CONCLUSIONS: The creation of a continent cecostomy for antegrade continence enema is a successful management option in children with debilitating fecal incontinence, and may enable undiversion of an existing colostomy. The appendix and ileal segment are viable options for the procedure, with no significant difference noted in continence or complication rates.

Adolescent↗
PubMedDate not supplied

Acute obstruction in cancer of the colon and rectum.

Results after operations for acute obstruction of the large intestine due to cancer were analyzed during a 10-year period and compared with the results after operations for nonobstructive tumors during the same period. The following conclusions could be deduced: 1) Cancer is more often obstructive in the colon than in the rectum. Cancers of the splenic flexure are relatively more often obstructive than cancers in other parts of the colon. 2) Postoperative morbidity (and probably mortality) is higher and the five-year survival shorter in patients with obstructive cancers of the large intestine than in those without obstruction. Obstructive Dukes' A tumors are very few. 3) The early morbidity and mortality after acute cecostomy are probably not higher than after acute transversostomy, if the cecostomy wound is left open. The cecostomy carries a risk of peritoneal contamination. 4) Cecostomy does not relieve obstruction in 5-10 per cent of the patients, while transversostomy seems always to be effective. Emergency exploratory laparotomy for obstructive cancer of the large bowel instead of a blind cecostomy reduces the number of patients who need two operations by 10 per cent. 5) Hernias are frequent at the sites of previous spontaneously closed cecostomies. 6) Antibiotic bowel preparation seems not to be effective shortly after decompressive colostomy.

Adult↗
PubMed1998

Effect of carbon dioxide pneumoperitoneum on bacteremia and severity of peritonitis in an experimental model.

BACKGROUND: Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteremia. METHOD: In 60 rats peritonitis was induced by cecostomy. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) was computed based on histology from peritoneal biopsy. RESULTS: One hour after cecostomy neither in abdominal swabs nor in blood samples bacteria were reproduced in PP and control groups. Three hours after cecostomy the frequency of positive blood cultures was 80% and 20% in PP and control groups, respectively (p < 0.0001). Six hours after cecostomy the frequency of positive blood cultures was 100% in each group (p > 0.05). One hour after cecostomy the mean peritoneal severity score was significantly higher in the PP group than in the control group, but there was not any significant difference between groups 3 and 6 h after cecostomy. The mean peritoneal severity scores were found to be significantly increased with time when the PP groups compared with each other. CONCLUSION: In rats, pneumoperitoneum can't cause a more severe peritonitis but it does induce an increase in the rate of bacteremia within the early 6-h period of peritonitis.

Acute Disease↗
PubMedDate not supplied

[Success of antegrade enemas in children with functional constipation].

AIM: To assess the benefit of antegrade enemas via cecostomy in children with functional constipation unresponsive to medical treatment. METHODS: A retrospective chart review identified 19 children (12 male, age 10.4 +/- 4.3 yrs) who from 1998-2001 underwent placement of a cecostomy for administration of antegrade enemas. All children were neurologically normal, suffered from functional constipation; all had a history of using multiple medications, having daily soiling, and 65% had prior hospitalizations due to fecal impaction. Sixteen of 19 children had undergone colonic manometry which ruled out colonic inertia. One of 3 irrigation solutions: polyethylene glycol (65%), saline and glycerin solution mix (10%) and phosphate enema (25%) administered through the cecostomy everyday in 14 children or every other day in 5 children. We used a questionnaire to interview caregivers, a mean of 21.1 +/- 24.9 mo after cecostomy placement. RESULTS: In all patients antegrade enemas led to significant improvement of: bowel movements/wk (7.4 vs. 1.4, p < 0.001), soiling accidents/wk (1.1 vs. 6.1, p < 0.001), emotional health score (3.8 vs. 1.8, p < 0.001), overall health score (3.7 vs. 1.8, p < 0.001), number of medications for constipation (0.8 vs. 4.2, p < 0.001), number of missed school days/mo (1.3 vs. 10.5, p < 0.001), and number of physician office visits/yr (7.7 vs. 24.1, p < 0.002). Eight patients have been able to discontinue the use of the antegrade enemas within a mean of 19.9 +/- 14.2 mo after beginning treatment. CONCLUSION: Antegrade enemas are an alternative effective way for treating severe cases of functional constipation unresponsive to medical management.

Cecostomy↗
PubMed2002

Surgical management of chronic unremitting constipation and fecal incontinence associated with megarectum: A preliminary report.

BACKGROUND/PURPOSE: Functional constipation with associated fecal incontinence responds poorly to medical management once megarectum has developed. The authors describe resecting the dilated rectum and inserting a cecostomy button for antegrade enemas in this difficult condition. METHODS: Four children, ages 9 to 15 years, with a history of unremitting constipation and fecal incontinence were referred for evaluation after not responding to medical management. All patients had exhibited normal lumbosacral magnetic resonance images (MRI) and open rectal biopsies; however, all 4 patients had a megarectum on contrast enema. In addition, anorectal manometry was consistent with functional fecal retention. The dilated rectum was resected by anastamosing the nondilated sigmoid colon to the distal rectum, and a standard gastrostomy button was inserted into the cecum for antegrade enemas. Mean follow-up was 35 months (range, 8 to 60 months). RESULTS: Constipation and incontinence resolved within 6 months in all patients, and all children remained continent without the aid of cathartic agents. There were no postoperative episodes of fecal impaction. The only complication was antibiotic-associated diarrhea in 1 patient. Cecostomy buttons were removed at 1 year postplacement in all 4 patients with continued success. Three patients underwent repeat anorectal manometry; all 3 had normal rectal sensory threshold volumes and anorectal inhibitory reflexes. Barium studies also were obtained in the 3 patients without evidence of recurrent rectal dilation. CONCLUSIONS: Refractory constipation and incontinence associated with megarectum may be amenable to surgical intervention in selected patients. The authors' limited experience suggests that proctectomy and button cecostomy is an effective treatment option that improves the quality of life in these patients. Furthermore, proctectomy alone may be curative.

Adolescent↗
PubMed2002

Management of intractable constipation with antegrade enemas in neurologically intact children.

OBJECTIVES: To assess the benefit of antegrade enemas in children with severe constipation who were referred to a tertiary care center. METHODS: From 1997 to 1999, 12 children (9 male, aged 8.7 +/- 4.4 years) underwent cecostomy placement. All children were neurologically normal and had been extensively examined to rule out organic causes of constipation. Follow-up included a questionnaire to interview caregivers 13.1 +/- 8.5 months after cecostomy placement. RESULTS: For all children, antegrade enemas led to improvement in the number of bowel movements / week (7.1 versus 1.4, P < 0.005), number of soiling accidents / week (1.0 versus 4.7, P < 0.01), abdominal pain score (0.9 versus 2.9, P < 0.005), emotional health score (3.6 versus 1.9, P < 0.005), overall health score (3.6 versus 1.7, P < 0.005), number of medications used for constipation (0.8 versus 4.0, P < 0.005), number of missed school days / month (1.5 versus 7.5, P < 0.02), and number of physician office visits / year (9.2 versus 24.0, P < 0.05). Irrigation solutions used for the antegrade enemas included polyethylene glycol (67%), saline and glycerin solution (25%), and phosphate enema (8%), administered everyday in seven children and every other day in five children. Adverse events included skin breakdown and granulation tissue in one patient, leakage of irrigation solution in one patient, and dislodging of the tube in two patients. Five patients discontinued the use of antegrade enemas within a mean of 14.6 +/- 9.1 months after beginning treatment. CONCLUSION: Antegrade enemas through a cecostomy are a safe and satisfactory option for children who are neurologically intact and who have severe constipation that does not respond to medical treatment.

Cecostomy↗
PubMed1999

Continent urinary undiversion to modified ureterosigmoidostomy in bladder extrophy patients.

The objectives of urinary diversion are expanding from merely preserving kidney functions to enabling the patient to have a good quality of life while maintaining an acceptable certain body image. During the new era of continent urinary diversion the psychological drawbacks of noncontinent skin stoma in young adolescents cannot be overlooked. Ureterosigmoidostomy has been the technique of choice for continent urinary diversion in bladder extrophy patients when bladder reconstruction is not feasible or has failed. Although it provides a good daytime continence it is associated with a high rate of nighttime incontinence and delayed complications of pyelonephritis and hyperchloremic acidosis. We managed five male bladder extrophy patients with noncontinent skin stoma (sigmoid colon conduit in three and ileal conduit in two) including two patients who had previously had complicated classic ureterosigmoidostomy. They underwent urinary undiversion to the valved and augmented rectum (three patients) and the valved S-shaped rectosigmoid pouch (two patients) with some modifications. The conduit was used in the construction, and the ureters were implanted behind an isolated intussusception ileal nipple valve. Tube cecostomy and total parenteral nutrition was used for 7 to 10 days instead of a temporary defunctioning transverse colostomy. With a mean follow-up of 19.8 months (range 9-36 months) all the patients are fully continent during the day and night, with an emptying intervals of 3 to 6 hours. Follow-up intravenous pyelography and renal scans revealed improvement or stabilization of the function and configuration of the upper tracts in all renal units. No prophylactic alkali therapy was given. No clinical evidence of acidosis or symptomatic urinary tract infection was observed. Modified ureterosigmoidostomy is a good alternative for continent urinary undiversion even in those who have previously had complicated classic ureterosigmoidostomy. Our modification of using tube cecostomy and parenteral nutrition instead of a temporary transverse colostomy warrants attention; it made the technique simpler and more attractive.

Acidosis↗
PubMed1995

Cecal infusion of nutrients improves nutritional status of rats.

The role of colonic fermentation in providing energy was investigated in rats with small bowel transection (T) or 80% resection (SBR). Rats were randomized to receive for 12 d either saline (S) or the enteral solution (E) through a cecostomy to meet 30% of energy requirement; the rest (70%) was provided by parenteral nutrition. Although SBR-S rats lost weight significantly compared with d 1 of the study, SBR-E rats gained. Significantly greater carcass wet weight and fat were found in SBR-E and T-E rats compared with SBR-S and T-S rats. SBR-E and T-E rats had significantly greater colonic mucosal dry weight and protein compared with SBR-S and T-S rats. Cecal short-chain fatty acid (SCFA) contents were also significantly higher in SBR-E and T-E rats compared with SBR-S and T-S rats. There was no significant effect of surgery (T vs. SBR) on any of the variables studied. These results suggest that the products of fermentation of an enteral solution infused through a cecostomy contribute substantially to energy requirement, maintenance of body composition and nutritional status of rats.

Animals↗
PubMed2004

Acute colonic pseudo-obstruction following cesarean delivery.

Acute colonic pseudo-obstruction remains an uncommon complication in obstetric practice, but when it occurs, it is most frequently noted after cesarean delivery. Acute colonic pseudo-obstruction is characterized by the findings consistent with large bowel obstruction in the absence of a demonstrable mechanical cause as noted in this case report. We report the occurrence of acute colonic pseudo-obstruction post-cesarean delivery in which prompt recognition of impending cecal perforation allowed appropriate management by tube cecostomy. Although acute colonic pseudo-obstruction is uncommon, it is important that obstetric practitioners recognize this clinical entity as the potentially fatal consequences of cecal perforation can be prevented by tube cecostomy.

Acute Disease↗
PubMed1990

Cecal pseudo-obstruction. Early therapy should be nonoperative.

This study was undertaken to ascertain the role of colonoscopy and surgery in patients with pseudo-obstruction of the cecum. Twenty-eight patients developed cecal pseudo-obstruction (cecal diameter ave., 13.6 cm +/- 2.0; range, 10-18 cm) and 25 of these 28 (89%) were hospitalized for nonabdominal problems. Significant comorbidities existed in all patients. Multimodal therapy was used in most: nasogastric (NG) suction (100%), rectal tube (64%), laxatives (64%), enemas (57%), Colonoscopy (57%), and surgery (25%). Twelve of 18 patients receiving rectal tubes, 14 of 18 receiving laxatives, 11 of 16 receiving enemas, and 12 of 16 (75%) undergoing colonoscopy avoided surgery; colonoscopy cured 44 per cent of the patients, was useless in 38 per cent, was detrimental in 6 per cent, and was temporizing in 12 per cent. Seven of the 28 patients (5 cecostomy, 2 right hemicolectomy) underwent surgery. Four of the seven patients (57%) had significant surgical complications such as wound infection, incisional hernia, cecal prolapse with infarction/death, and evisceration/death. Twenty-four patients of the 28 (86%) survived the index admission; Two of four patients died of the systemic problems that brought on cecal pseudo-obstruction and two of four patients died as a result of cecostomy complications. Pseudo-obstruction occurs in older, debilitated patients generally hospitalized because of nonabdominal problems. Treatment should be aimed at correcting the underlying cause; multimodalities often temporize until underlying problems are corrected and pseudo-obstruction resolves. Colonoscopy is often curative, occasionally helpful, and rarely harmful. Surgery is curative but carries significant risks. Uncomplicated cecal dilatation to 10-18 cm is tolerated; early operative intervention should not be dictated by cecal size alone.

Adult↗
PubMed1993

[Intermittent cecal volvulus. Report of 2 cases].

In our country, acute cecal volvulus is responsible of 3.3% of mechanical large bowel obstructions. More than half of these cases have a history compatible with intermittent cecal volvulus, an usually overlooked diagnosis. The author reports two cases of intermittent cecal volvulus, treated in the last ten years. Both patients are female, aged 45 and 71 years old, with a history of 3 and 5 years of recurrent abdominal distention located in the right lower quadrant, that relieves spontaneously after the expulsion of gases or defecation. The symptomatology of the first cases was erroneously attributed to a concomitant colonic diverticulosis and the patient was subjected to a elective sigmoidectomy. The right colon and cecum was observed located in the right lower quadrant during the operation, and an appendectomy and a tube cecostomy for cecopexia were performed. The postoperative evolution was uneventful, and the patient is asymptomatic nine years later. The diagnosis in the second case was performed with a barium enema and a cecostomy for cecopexia was performed. The patient is asymptomatic two years later. The anatomical prerequisite for this condition is a lack of fusion of ascending colon to parietal peritoneum, which allows free rotation of this segment. The diagnosis must be suspected in patients with chronic and recurrent abdominal distention and must be confirmed with a barium enema. The surgical treatment consist in the fixation of the ascending colon.

Abdominal Pain↗