In support of blind tube cecostomy in acute obstruction of the descending colon. Analysis of ninety-three emergency cecostomies.
Explore the source record for details and available documents.
Acute Disease↗
SEARCH · Search PubMed
Results for “Cecostomy”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Is tube cecostomy safe in the surgery of Hirschsprung's disease?
The use of concomitant tube cecostomy remains an option for decompression after distal large-bowel surgery but has been criticised because of a reported high complication rate. Two hundred and three patients who underwent a Soave endorectal pull-through procedure for Hirschsprung's disease (1974-1990) were evaluated. Operative technique included a modified sutured Soave endorectal pull-through procedure and a Stamm tube cecostomy utilising a large-lumen catheter. One hundred and twenty patients who had a modified two-stage procedure plus concomitant tube cecostomy were compared with 83 patients who underwent a three-stage procedure with colostomy cover. Early postoperative complications occurred in 8 patients (6.6%) in whom cecostomies were performed. A distal cuff abscess developed in 1 patient (0.8%), an anastomotic leak in 1 (0.8%) and 3 patients (2.5%) had colo-anal stenosis. The cecostomy tube dislodged in 2 patients and 1 required operative closure of a faecal fistula at the cecostomy site. Colonic venting was adequate and little nursing care was required. In 2 instances colonic distension developed after cecostomy clamping. Decompression was achieved by opening the cecostomy tube; this resulted in relief of symptoms and a good subsequent recovery. In contrast, there were 11 postoperative complications in the 83 patients undergoing a three-stage procedure (13.2%). In 2 patients (2.4%) an anastomotic leak occurred and 5 distal cuff abscesses (6%), 3 (3.6%) early strictures and 1 (1.2%) neorectal retraction developed. The use of a concomitant tube cecostomy with a two-stage Soave procedure is an effective and safe means of providing proximal colonic venting and did not add to mortality or morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
Cecostomy↗
Cecostomy. Therapeutic indications and results.
PURPOSE: The role and effectiveness of catheter tube cecostomy as a means of colonic decompression are not clearly defined. Our aim was to clarify the clinical indications, functional performance, and concomitant morbidity associated with tube cecostomy. METHOD: This was a retrospective chart review of patients receiving catheter tube cecostomy at the Mayo Clinic over an 11-year period. RESULTS: Sixty-seven patients (median age, 69 years) had catheter tube cecostomy placement. Clinical indications for tube cecostomy were colonic pseudo-obstruction, distal colonic obstruction, cecal perforation, cecal volvulus, preanastomotic decompression, and miscellaneous usage. Operation was emergent in 43 (64 percent) patients and elective in 24 (36 percent) patients. Tube cecostomy was the primary procedure in 47 (70 percent) patients and complimentary in 20 (30 percent) patients. Minor complications were seen in 30 patients (45 percent), including pericatheter leak, superficial wound infection, tube occlusion, skin excoriation, premature tube dislodgement, colocutaneous fistula, and ventral hernia. No patient required reoperation for tube-related morbidity. CONCLUSIONS: Catheter tube cecostomy is of therapeutic value in select clinical situations including refractory colonic pseudo-obstruction, cecal volvulus, cecal perforation, or distal colonic obstruction. Proper patient selection, careful tube placement, and vigilant postoperative tube care should provide adequate function with minimal morbidity.
Adolescent↗
Diagnostic laparoscopy and laparoscopic cecostomy for colonic pseudo-obstruction.
Marked cecal dilatation due to colonic psuedo-obstruction (Ogilvie's syndrome) is most often treated by colonoscopic decompression. When this fails, cecostomy is usually indicated if the bowel is not infarcted. We describe a new technique of laparoscopy-guided percutaneous cecostomy using T-fasteners to retract and anchor the cecum to the anterior abdominal wall and using a Foley catheter as a cecostomy tube. We performed this procedure successfully in a patient with colonic pseudo-obstruction who had marked cecal dilatation that could not be decompressed by colonoscopy. Laparoscopic inspection showed that the cecum was viable, and a laparoscopic cecostomy was placed. This procedure can be performed easily and safely and with much less morbidity than laparotomy and open cecostomy.
Aged↗
Tube cecostomy and staged resection for obstructing carcinoma of the left colon.
Over a 17-year period, all patients presenting with acute obstruction of the left colon due to carcinoma were treated by emergency tube cecostomy. There were 57 patients aged between 35 and 93 years. After the decompressive procedure, eight died, 34 had complications, and eight were left with permanent cecostomies. Forty-one underwent secondary procedures of which 35 had resections. Seven patients died postoperatively and 15 had complications. Of the 34 survivors, in 23 the cecostomy closed spontaneously, and 11 had operative cecostomy closure. Of the latter, four died postoperatively, and nine had complications. Thus, 30 survived the entire treatment program. Reasons for the high morbidity and mortality are discussed. Comparison is made with other forms of treatment in the literature. A treatment program is suggested, using tube cecostomy for poor-risk patients and primary resection without anastomosis for patients in better condition.
Adult↗
[Is cecostomy still current for emergency relief of the colon?].
The policy of treatment in patients with acute obstruction of the left colon remains controversial. One-stage emergency colectomy and primary anastomosis is usually recommended. Is a multiple-stage approach with primary blowhole cecostomy still a valuable solution? This retrospective analysis of 117 patients with emergency cecostomies shows an overall perioperative mortality and morbidity which are favourable compared with those reported in series of similar cases treated by one-stage procedures. In all patients the colon obstruction was treated effectively by the cecostomy. Only two of the stoma-related complications required operative intervention. The second operation was performed after a mean interval of 12 days. The low perioperative mortality of 2.1% shows, that the time was successfully used to optimize the perioperative conditions. It is concluded that patients with a very poor risk may profit by preliminary decompression by blowhole cecostomy.
Aged↗
[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↗
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↗
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↗
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↗
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↗
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↗
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↗
[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↗
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↗
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↗
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↗
Percutaneous cecostomy: a new technique in the management of fecal incontinence.
A pilot study on the percutaneous introduction of a cecostomy tube for colonic irrigations in the treatment of children with fecal incontinence is described. The results were good, and the technique is recommended for certain patients.
Adolescent↗