Fecal Leakage Research Articles

The Known Hazards of Ureterosigmoidostomy

Macfarlane et al1 have pointed out the unheralded hazard of patients with ureterosigmoidostomy: leakage of foul-smelling urine and feces into their beds or underpants and frequent interruption of their sleep due to their inability to remain continent at night. The authors stated: "Why this aspect of ureterosigmoidostomy has gone unnoticed for so long may be due to the fact that this was a treatment for conditions of enormous magnitude ... and the patients may feel that any result that keeps them alive is acceptable...." The "unheralded" hazards decribed by Macfarlane et al have not been disregarded.

1. Karaya Seal Drainable Stoma Pauch with Microporous Adhesive

New ostomy appliance of Karaya seal drainable pouch with microporous adhesive was fitted to 50 ostomists who had been rehabilitized. They were instructed to wash out inside the pouch without removal of the appliance. Confidential questionaires were provided for assessing of eleven items. Each items graded 0 (the best) to 5 (the worst) and treated statistically. Three ileostomists and 39 colostomists responded. Tolerated duration of adhesion per an appliance was 3.2 days in the mean, 12 days in the maximum. Holding-power was 1.6 grade in the mean, while separation was nonpainful (0.7 grade). Fitting of the appliance was excellent (0.9 grade). Its change while sweating was minimal (0.9 grade). Odor leakage was seldom (1.1 grade), and fecal leakage was limited only on some diarrhea (0.8 grade). Management of defecation was easy with wash-and-drain method (1.7 grade). Skin irritation was rarely occurred (0.5 grade) and only one patient developed vesicles. In 26 out of 31 cases peristomal dermatitis was improved or healed completely within 4 weeks.Most of them felt comfortable (1.2 grade) and their general impression for the appli-ance was 1.0 grade : The best in 7 cases, excellent in 22, good in 9, fair in 2, worse in one, and the worst in one case of ileostomy.The data showed that this new appliance was effective in 84% for treatment of peristomal dermatitis and that this was also preventive for skin irritation.

Perforated sigmoid diverticulitis with spreading peritonitis

The mortality in this series of nineteen patients with perforated sigmoid diverticulitis with spreading peritonitis was 47 per cent. Persistent peritonitis resulting in death and regional complications consisting of inflammatory bowel obstruction, fecal fistula, pelvic phlebitis, intraperitoneal abscess, and upper gastrointestinal bleeding are believed to be related to the therapeutic inadequacy of a proximal colostomy with drainage of the peritoneal cavity. In the presence of free communication between the perforation and the general peritoneal cavity, continued bacterial contamination occurs because of leakage of feces retained in the colon between the colostomy and the site of perforation. In consonance with other recent reports, encouraging results in three patients have been achieved by elimination of this source of continued contamination by exteriorization of the colon at the site of perforation or by resection with proximal end colostomy. The mortality in this series of nineteen patients with perforated sigmoid diverticulitis with spreading peritonitis was 47 per cent. Persistent peritonitis resulting in death and regional complications consisting of inflammatory bowel obstruction, fecal fistula, pelvic phlebitis, intraperitoneal abscess, and upper gastrointestinal bleeding are believed to be related to the therapeutic inadequacy of a proximal colostomy with drainage of the peritoneal cavity. In the presence of free communication between the perforation and the general peritoneal cavity, continued bacterial contamination occurs because of leakage of feces retained in the colon between the colostomy and the site of perforation. In consonance with other recent reports, encouraging results in three patients have been achieved by elimination of this source of continued contamination by exteriorization of the colon at the site of perforation or by resection with proximal end colostomy.

Control of the colostomy.

The goal of colostomy control (of the sigmoid colostomy) is the attainment by the patient of security, normal activity, and freedom from the fear of fecal leakage. The sentinels which guard this security are psychologic adjustment, a well-constructed stoma, an efficient system of irrigation, a suitable interval between irrigations, and an adequate diet suited to the patient, which avoids diarrhea and produces constipation without impaction.

Certain Limitations of the Bacillus coli method in Water Examinations

Contradictory opinions are at present held on the subject of bacterial standards of purity of water in India. My recent researches tend to throw some light on some of the causes of this divergence of opinion. The presence of frogs in water has been found to be responsible for an increase in faecal bacilli which, though negligible in the case of large bodies of water, is apt to be misleading in the case of waters of great purity. Stasis in reservoirs and passage through pipes may be responsible for a considerable increase in faecal bacilli in water, so that a mere increase in the number of faecal bacilli in a reservoir or pipe water does not necessarily indicate faecal contamination but may simply be due to stasis in reservoirs or flow through pipes. These findings lead to two conclusions of importance in regard to the bacteriological examination of water: (1) in testing for the bacterial efficiency of sand filters, samples should be collected from the filter well and not from the clear water reservoir where water is usually stagnant for some hours; (2) in interpreting the results of the examination of pipe waters the possibility of an increase of B. coli having occurred through multiplication in the pipes should always be borne in mind before inferring that such increase is indicative of faecal contamination or leakage in the mains.