Gastrointestinal Stoma Research Articles

Insertion of a self-expanding metal stent for a stomal stenosis

Stenosis is one of the major complications of a gastrointestinal stoma, yet its treatment is not well established [1] [2] [3]. We report a case of stomal stenosis that improved after insertion of a temporary self-expanding metal stent (SEMS). A 61-year-old woman presented with a stoma that had been malfunctioning for 2 months. She had been diagnosed with recurrent cervical cancer and admitted 7 months previously because of life-threatening rectal bleeding. The bleeding had come from a branch of the internal iliac artery and had passed through a tract formed between the rectum and the recurrent cervical cancer by a necrotic abscess. She had been treated with emergent transarterial embolization and coiling and had subsequently undergone a T-loop transverse colostomy with stoma formation to prevent stool passing into the tract. For the past 2 months, however, her stools had been mainly passing out through her urethra and anus, rather than through the stoma.

A literature review of gastrointestinal stoma complications

A literature review of gastrointestinal stoma complications

A literature review of gastrointestinal stoma complications

A literature review of gastrointestinal stoma complications

A literature review of gastrointestinal stoma complications

A literature review of gastrointestinal stoma complications

Antiperistaltic (Retrograde) Intussusception after Roux-en-Y Gastric Bypass

Adult intussusception has been described after various types of gastrointestinal surgery. In some instances there may be intussusception of the jejunum into the stomach via a gastrointestinal stoma, a rare complication known as jejunogastric intussusception (JGI). We present a retrospective review of two cases of retrograde intussusception occurring years after open Roux-en-Y gastric bypass (RYGB) for morbid obesity. To our knowledge there have been no documented reports of JGI occurring after RYGB and only scattered reports of JGI after Roux-en-Y reconstruction in general. Two reports of intussusception following RYGB were identified in the English literature and comprised three patients, only one of whom suffered a retrograde intussusception. As the number of RYGB procedures continues to rise, we will likely see more of this entity; and it is therefore crucial that surgeons consider acute and chronic intussusception as a cause of abdominal pain in patients who have undergone RYGB.

Stoma Complications: A Multivariate Analysis

Construction of a gastrointestinal stoma is a frequently performed surgical procedure. We sought to analyze a large cohort to document the frequency and types of ostomy complications and the risk factors associated with them. The charts of patients undergoing a procedure which resulted in ostomy during a 3-year period were reviewed. Demographics, indication, ostomy type/location, perioperative risk factors, and complications were recorded. Case-control methodology was used to determine crude odds ratios and multiple logistic regression was used to calculate adjusted odds ratios. A P value of less than 0.05 was considered significant. An ostomy was constructed in 204 patients and records were available for 164. Forty-one patients (25.0%) had ostomy complications. Sixteen of these complications (39.0%) occurred within one month of the procedure. Complications included prolapse in nine (22%), necrosis in nine (22%), stenosis in seven (17%), irritation in seven (17%), infection in six (15%), bleeding in two (5%), and retraction in two (5%). Gender, cancer, trauma, diverticulitis, emergency surgery, ileostomy, and ostomy location/type were not associated with a stoma complication. Significant predictors of ostomy malfunction are presented as odds ratios (ORs) with 95 per cent confidence intervals (CIs) and include inflammatory bowel disease (OR = 4.49; 95% CI = 1.16-17.36) and obesity (OR = 2.66; 95% CI = 1.15-6.16). The care of an enterostomal nurse was found to prevent complications (OR = 0.15; 95% CI = 0.03-0.69). We conclude that ostomies have a high risk of complication, which is not related to stoma location or type. Obesity and inflammatory bowel disease predispose to complications. Enterostomal nursing may be instrumental in preventing complications.

退院後の消化器系永久ストーマ造設患者のための生活安定感尺度の開発

退院後の消化器系永久ストーマ造設患者のための生活安定感尺度の開発

LYSOZYME ACTIVITY OF CYSTIC MUCOSAL AND SUBMUCOSAL GLANDS IN THE STOMAL AREA OF THE GASTRIC REMNANT

In order to study the lysozyme activity in the cystic mucosal and submucosal glands in the stomal area of the gastric remnant, which is one of the components of gastritis cystica polyposa, we carried out a pathological and immunohistochemical examination of 55 patients with gastric remnants, including 19 with stomal carcinoma, after partial gastrectomy for benign gastro-duodenal diseases. These stomach specimens were examined immunohistochemically for lysozyme. The cytoplasm of some epithelial cells of cystic mucosal and submucosal glands, which showed characteristic changes in the gastro-intestinal stoma as well as background changes in the stomal carcinoma, showed a strongly positive reaction for lysozyme. These strongly lysozyme-positive cells in the cystic mucosal glands appeared more frequently in the cases of stomal carcinoma than in the non-cancerous controls.

Surgical aspects of the Tenckhoff peritoneal dialysis catheter: A 7 year experience

The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.

Copper Metabolism and Requirements in Total Parenteral Nutrition

Copper metabolism and requirements in patients receiving total parenteral nutrition were studied in 28 patients with gastrointestinal diseases. During each of the 3 wk of the study period, each of 24 patients received in their total parenteral nutrition solutions, a daily dose of copper amounting to 0.25 mg, 1.05 mg, or 1.85 mg, in a random order. The other 4 patients received a fixed daily dose of 1 mg throughout the 3 wk. Increased losses of copper through the gastrointestinal tract occurred in patients with diarrhea or high-output stomas or fistulas. Patients with abnormalities of liver excretory functions had decreases in gastrointestinal copper losses. Urinary copper excretion was twice that of normal subjects. Copper infused in excess of the requirements was retained and not excreted. Plasma copper did not reflect the copper balance and cannot be used as a guide for copper supplementation. Copper requirements were found to be 0.3 mg/day in patients with normal amounts of gastrointestinal excretion. In the presence of diarrhea or increased fluid loss through gastrointestinal stomas or fistulas, the copper requirements for total parenteral nutrition are 0.4--0.5 mg/day.