Colonoscopic assisted trephine stoma in children with chronic constipation.

Abstract

BACKGROUND In extreme cases, faecal diversion is required for children with chronic constipation and megarectum. Formation of a proximal ‘trephine’ sigmoid colostomy avoids the need for and the associated morbidity of a formal laparotomy. We describe a technique that combines intraoperative unprepared colonoscopy with a diverting ‘trephine’ sigmoid colostomy. TECHNIQUE The stoma site is marked preoperatively. Under anaesthesia, the patient is positioned in the supine frog leg position. The surgeon inserts a flexible colonoscope, and makes an assessment of the unprepared megarectum, sigmoid and proximal colon. Bright light transillumination (Fig 1) and finger indentation are used to assess the location and mobility of the sigmoid colon. The stoma site is established after consideration of the preoperative mark and the position of the transillumination. A trephine stoma is performed as described by Senapati and Phillips. 1 The sigmoid loop containing the colonoscope is easily located and delivered into the wound (Fig 2). The assistant then slowly withdraws the colonoscope to confirm which end is distal (Fig 3). An end colostomy is formed, with a non-dissolving marking suture left on the distal stump (Fig 4). The