[Colostomy care with irrigation--an alternative to the colostomy bag: colostomy care with irrigation has definite advantages].
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Colostomy↗
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Colostomy and colostomy closure.
A series of 181 adult patients subjected to colostomy was studied, almost all of whom had disease rather than injury. The complication rate was 28 per cent. One hundred of these patients had a subsequent colostomy closure with a complication rate of 17 per cent. Of the patients who had both procedures, 35 (35 per cent) had one or more significant complications. The causes and prevention of these complications are described.
Adult↗
Obturating balloon colostomy (Torbay colostomy): preliminary communication.
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Colostomy↗
Technique for conversion of a loop colostomy to a diverting colostomy.
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Colostomy↗
Options in practice: transverse loop colostomy in midline incision. Descending loop colostomy over a Hollister bridge.
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Aged↗
The present role of colostomy in the management of trauma.
The role of colostomy in the treatment of abdominal trauma has changed over the past several decades. Primarily as a result of its successful use in military settings, colostomy initially was the mainstay of treatment for penetrating injury to the colon, rectal injury, and some forms of blunt trauma. Subsequent civilian experience with the techniques of primary repair of penetrating colon injury resulted in a decrease in the number of colostomies performed. Coupled with this experience, early data on adverse outcome from colostomy closure tended to support the trend of the ever-diminishing place of colostomy for trauma. Colostomy has always been used for two purposes in trauma care: prevention or arrest of fecal contamination of the peritoneal cavity and diversion of the fecal stream. Despite the decreased need for colostomy in some forms of penetrating colon injury, there are several conditions that still utilize colostomy to accomplish one or both of these purposes. Indications for colostomy can now be regarded as absolute or relative depending upon the need for diversion or the requirement to prevent contamination. There are relatively few contraindications to colostomy use. Present results of colostomy closure do not represent excessive risk to the patient and should not impact negatively on the decision to perform a colostomy for trauma.
Abdominal Injuries↗
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↗
[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↗
Colostomies--indications and contraindications: Lahey Clinic experience, 1963--1974.
Over a 12-year period, 276 temporary colostomies were performed on 271 patients. During this interval 118 colostomies were closed. The morbidity rate of colostomy construction was 21 per cent, and for closure it was 49.1 per cent. No definite factor could be indentified as contributing to this high rate of complications for colostomy construction. With respect to colostomy closure, predisposing factors that seemed to increase morbidity were shorter interval between creation and closure of the stoma and resection of colostomy (as opposed to closure without resection). Intra-abdominal drains were associated with a prohibitively high rate of wound infection, although subcutaneous drainage was not successful in reducing the incidence of infection significantly.
Adolescent↗
Umbilical colostomy: a better intestinal stoma.
This study was undertaken to evaluate our experience with umbilical colostomy. There were 101 cases available for review. Four patients had major complications that necessitated reoperation, an incidence of 3.9%. One patient was operated on for necrosis of the stoma, one for retraction, and two for periostomal evisceration of omentum and small bowel. Three patients had minor strictures requiring digital dilatation, and one needed minor revision under local anesthesia. No patient had a peristomal hernia or prolapse, making this a distinctly better colostomy than the conventional left-lower-quadrant colostomy. The ease and comfort in the care of this colostomy were evident during follow-up visits. We feel that this procedure has all the advantages of a conventional matured colostomy and has extra advantages of easy accessibility and absence of peristomal hernias and prolapse. For any elderly patient who needs a permanent colostomy, umbilical location of the stoma offers distinct advantages.
Aged↗
Imperforate anus: avoiding a colostomy.
Early assessement of imperforate anus, combining clinical and radiographic data, determines the course of treatment. "High" lesions most often require combined abdominal and sacroperineal repair, usually preceded by a decompression colostomy. "Low" lesions are repaired through a perineal or sacroperineal approach not requiring a previous colostomy. Patients who do not have an apparent fistulous tract through which accurate radiographic assessment can be made frequently undergo preliminary colostomy to avoid colonic perforation. This occurs in patients who have "low" lesions and in whom colostomy may be avoided. Combining a new procedure and an old procedure may avoid unnecessary colostomy. A 14 Medicut intravenous cannula is inserted in the perineum and under fluoroscopic control is advanced into the radiolucent area identified in the pelvis as the probable lower rectal pouch. The position is confirmed by aspiration of gas or meconium and injection of contrast material. A limited contrast enema will clearly identify the level of the lesion and identify a fistula if one is present. If a low lesion is identified and no fistula is present to allow temporary colonic decompression, a fistulous tract may be created mechanically. A No. 4 Fogarty catheter is inserted through the previously placed cannula, the catheter balloon is inflated, and the entire apparatus is extracted under tension. This creates a small fistulous tract to the perineal surface. Subsequent dilation of this tract allows colonic decompression, and definitive operative repair may be planned at the most appropriate time. By employing this technique, we have avoided colostomy in 4 of 6 patients.
Anus, Imperforate↗
[Colostomy-induced varices in portal hypertension].
Varices of the colostomy are a rare complication of colostomy performed in patients with portal hypertension. This work is based on 14 cases. The colic stomy is the terminal operation in surgery for cancer in twelve cases, and a bypass stomy in two cases. Portal hypertension is due to cirrhosis in 10 cases and to metastases to the liver in 4 cases. All 14 colostomy varices were expressed by bleeding. In 7 cases, oesophageal varices were detected with fiberendoscopy. Only one of these patients had an upper digestive hemorrhage. Colostomy hemorrhages are the revealing complication and the main sign of the disease. The emergent treatment of bleeding of the colostomy must combine several methods, most often consecutively: local compression, ligation, sclerotherapy. Once bleeding is controlled, the radical treatment must be primarily medical (hygienic and dietary habits, beta-adrenergic blocking agents), but complementary surgery may prove to be necessary, most often to redo the colostomy with additional deconnection. The prognosis mainly depends on the function of the liver, the deterioration of which is accelerated by the successive hemorrhagic accidents. Hepatorenal failure is the main cause of death.
Aged↗
Morbidity after immediate and delayed opening of sigmoid end colostomy: a randomised trial.
OBJECTIVE: To see if sigmoid end colostomies that were opened immediately carried a higher early morbidity than those in which opening was delayed for 10 days. DESIGN: Randomised trial. SETTING: University department of surgical gastroenterology. SUBJECTS: All patients for whom a temporary or permanent end sigmoid colostomy was done between December 1986 and May 1989. INTERVENTIONS: 51 patients had their colostomies opened immediately, and in 49 opening was delayed. MAIN OUTCOME MEASURES: Presence of ischaemia, retraction, separation or infection, and length of stay in hospital. RESULTS: Two patients from each group died within the first week; none of the deaths was associated with complications of the colostomy. One patient whose colostomy had been opened immediately developed gangrene of the stoma, and one in whom the opening had been delayed developed retraction. There was no difference between the groups in length of stay in hospital. CONCLUSION: As we could find no differences in morbidity whether the colostomy was opened immediately or whether it was delayed, we now recommend that it should be done immediately. The question of late complications (stenosis and hernia), however, cannot be answered yet.
Cause of Death↗
Irrigation vs. natural evacuation of left colostomy: a comparative study of 340 patients.
A comparative study of two methods of managing left colostomy (irrigation and natural evacuation) was carried out on 340 patients who were examined and interviewed at the Stoma Rehabilitation Clinic of the Institute of Surgical Pathology of the University of Padua. Ninety-two per cent of patients who irrigated their colostomies gained fecal continence. No patient who irrigated his colostomy had any cutaneous problem, and this group had significantly better results in preventing leakage of gas and odors compared with those patients using natural evacuation. For most patients who irrigated, the ability to predict or control bowel movements overcame fears of "being dirty" and related psychological problems. These patients also had more normal social and working lives than did those patients not irrigating their colostomies. Only one patient in our series had a colonic perforation, and any chance of a repeat incident will probably disappear with the cone-shaped catheters now available. The authors conclude that in properly selected patients, irrigation is the method of choice for management of left colostomy.
Aged↗
Morbidity of colostomy closure.
An unexpectedly high morbidity (28 per cent) followed colostomy closure in 100 patients. One patient died postoperatively because of sepsis resulting from disruption of the colon anastomosis. Wound infection (10 per cent), intraperitoneal abscess (1 per cent), bowel obstruction (7 per cent), and fecal fistula (4 per cent) were other significant complications. Wound sepsis was greater after primary than after delayed wound closure. Obstruction did not correlate with the use of either an open or closed technic of anastomosis. Three patients required reoperation for complications. Temporary colostomy was constructed for colon injury in 85 per cent of patients. In view of the considerable morbidity of colostomy closure, alternate technics of managing colon trauma should be considered. Such technics include primary closure and exteriorization of repaired colon. When temporary colostomy is unavoidable, closure is best done by open, two layer anastomosis with delayed wound closure. Colostomy should be recognized as an important procedure associated with significant morbidity.
Abdominal Injuries↗
Improving transverse colostomy function.
Loop transverse colostomies as usually constructed without immediate mucocutaneous anastomosis function poorly even a year later, with diarrheal fluid output approaching 1 liter/day on a regular diet. In contrast, primarily matured end transverse colostomies produce an average of 750 cc/day at one month and 560 cc/day at nine to twelve months on a similar diet. A further reduction to 360 cc/day was achieved on an experimental 70 mEq sodium diet. It is suggested that end transverse colostomies with immediate maturation should be performed in all patients requiring a transverse colostomy for more than a very short time to markedly improve colostomy function.
Colon↗
Complications of colostomy performed on gynecologic cancer patients.
From 1/1/80 to 5/31/90 111 patients underwent a colostomy on a gynecologic oncology service. Six patients developed 7 (6.3%) early colostomy-related complications, including sepsis (1), stomal retraction (1), ostomy wound infection (3), and partial stomal obstruction (2). The sepsis was felt to be related to spillage of stool upon maturing the colostomy, and this patient expired on Postoperative Day 63. There were no other mortalities attributed to the colostomies. Fourteen patients developed 17 (15.3%) delayed colostomy-related complications, including parastomal hernia (5), stomal retraction (1), stomal prolapse (3), tumor replacement (2), and site-choice problems (6). These results compare favorably with those in the literature and support the continued role of the gynecologic oncologist in gynecologic cancer-related gastrointestinal surgery.
Adult↗
Self-image changes with time in the cancer patient with a colostomy after operation.
Persons undergoing colostomy surgery face body mutilation and some loss of body function, which in turn causes their concept of self to change. Although nurses use physical and behavioral indicators as bases for assessment, planning, and evaluation of nursing intervention, only minimal empiric data is available on the physical and behavioral indicators of self-concept changes (e.g., lack of participation in self-care, depression, anxiety, fear of social rejection) among these patients. This study is a beginning in the description of the self-concept changes with time of the patient with a colostomy. The purpose of this study was twofold: (1) to begin the description of the postoperative behavioral indicators of cancer patients with colostomies according to Erikson's stages of trust and autonomy at 4 and 12 weeks after operation; and (2) to measure several indexes of psychosocial discomfort anticipated by patients before colostomy operations and them measurements with measurements of psychosocial discomfort at 4 and 12 weeks after operation. The study design incorporated three serial assessments. Each consenting subject was interviewed once before the operation and twice after (at 4 and 12 weeks). The study sample consisted of 12 subjects who had colostomy operations for cancer. Ages ranged from 41 to 74 years, with a mean age of 59.4 years. Results show an increase in trust, from a mean of 203.6 at 4 weeks to a mean of 221.7 at 12 weeks. Autonomy scores decreased, from 146.2 at 4 weeks to 143.9 at 12 weeks. Psychosocial discomfort decreased from 25.7 before to 22.1 4 weeks after and 8.0 12 weeks for operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗