Transverse Loop Colostomy Research Articles

Impact of fecal diversion in Perineal Necrotizing Soft Tissue Infection on disease survival: A large retrospective study

IntroductionColostomy is usually proposed during the acute phase of Fournier Gangrene, nevertheless its impact on disease outcome remains still debated. We conducted a retrospective study in an academic center to determine the impact of fecal diversion on disease morbidity and specific survival. MethodsAll medical charts of Fournier Gangrene cases in the past 30-years were reviewed. Mortality rate, hospitalization duration, time to complete healing and number of excision surgeries were compared between the stoma and the non-stoma groups. Time between initial diagnosis and stoma creation, type of fecal diversion, as well as specific morbidity were analyzed. ResultsOf 89 patients included, 59 had stoma creation. Stoma group had significant higher catecholamine drugs use. Mortality, time to complete healing and number of excision surgeries did not significantly differ between both groups. Hospitalization duration was significantly higher in the stoma group. Mortality and hospitalization duration were higher when loop transverse colostomy was performed, and when colostomy was done in the first 3-days. Morbidity occurred in 41 % of patients with colostomy, with 25 % life-threatening complications. 31 % of colostomies remained definitive, while median time to intestinal recovery was 159-days. DiscussionConsistently with current literature, disease survival was not improved by colostomy creation although skewed. Colostomy creation was associated with a higher hospitalization duration and a significant morbidity including risk of definitive stoma. To limit over-indicated stoma and improve early results, a damage control strategy using colostomy creation is advised. ConclusionThe benefit of colostomy during the acute phase of Fournier Gangrene was uncertain, with no clear impact on mortality. In fact, colostomy was associated with increased hospitalization duration and specific morbidity. Finally, when fecal diversion is deemed necessary, we advocate for coelioscopic delayed loop left colostomy. Alternative minimally invasive treatment as bowel catheters should also be discussed.

Emergency intestinal stomas incidence and early complications

Background: An intestinal stoma is a frequently performed procedure with a high percentage of complications. Even though creating an intestinal stoma is a procedure that can save lives while treating various gastrointestinal conditions, its accompanying morbidity and mortality have been the topic of many studies. This study was carried out in order to better understand a variety of complications in various types of intestinal stomas. Methods: A total of 60 patients with intestinal stoma construction in the general surgery emergency department at Kasr Al-Ainy emergency hospital Cairo, Egypt as an emergency procedure from December 2019 to May 2020 were included in this prospective cohort analysis. The inclusion criteria were all emergency cases undergoing intestinal stomas for treatment of either traumatic bowel injuries or acute abdominal surgical emergencies. Results: With a mean age of 45.18 years, 60 patients in all were evaluated. Males were 65% and females were 35%. End ileostomy with mucous fistula (33.3%) and loop transverse colostomy (18.30%) were the two stomas that were constructed most frequently. Intestinal obstruction (41.7%) was the most often reported indication of stoma formation. Complications of the peristomal skin made up the majority of cases (61.90%). Conclusions: This work significantly advances our understanding of stoma problems and their prevention to some extent through pre-operative soma site marking, good surgical technique, an experienced surgeon, a stoma therapy nurse, and patient education to enhance the care and quality of life for those who have stomas.

Early closure of colostomy from abdominal trauma may be beneficial in otherwise healthy patients

A clinical decision report using: Khalid MS, Moeen S, Khan AW, Arshad R, Khan AF. Same admission colostomy closure: a prospective, randomised study in selected patient groups. Surgeon. 2005;3(1):11-14. https://doi.org/10.1016/s1479-666x(05)80004-6 for a patient with loop transverse colostomy due to trauma

Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study.

Stomal prolapse (SP) is one of the most common complications of loop colostomy and can impair a patient's quality of life. Herein, we evaluated the risk factors for SP to prevent its occurrence after a transverse loop colostomy. This retrospective study included 84 patients who underwent loop transverse colostomy between January 2016 and December 2020. We evaluated the incidence of SP and examined the relationship between perioperative factors and SP using univariate and multivariate logistic regressions. SP occurred in 11 (13.0%) patients. Median time to SP was 99 postoperative days. In the univariate analysis, a right side abdominal wall stoma site, perioperative chemotherapy, and anti-VEGF antibody therapy were associated with a significantly higher incidence of SP. Multivariate analysis identified that construction of a temporary loop colostomy in the right transverse colon during rectal cancer surgery (odds ratio, 5.07; 95% confidence interval, 1.12-22.86) is an independent risk factor. In this study, multivariate analysis showed that the right side of the transverse colon was a risk factor for SP. Therefore, when constructing a transverse colon loop stoma, the stoma should be constructed in the left transverse colon to prevent SP.

Spontaneous closure of transverse loop colostomy: A case report

Colostomy is an artificial colo-cutaneous fistula which can be temporary or permanent, depending on the purpose for which it was created. The indications for colostomy include protection of a distal intestinal anastomosis, control of sepsis in open injury to the colon or rectum, to facilitate the operative treatment of a high anal fistula

Evaluation of the outcome of linear stapler anastomosis in comparison to hand-sewn anastomosis in elective loop transverse colostomy closure in children: a study in a tertiary care hospital, Dhaka, Bangladesh

Background: Conventional hand suture technique of intestinal anastomosis has been in vogue for decades. Staplers which developed to simplify surgery began to have significant impact. Objective were to see outcome of linear stapler anastomosis in comparison to hand-sewn anastomosis in elective loop transverse colostomy closure in children. Methods: This prospective interventional study was carried out in the department of pediatric surgery, Dhaka medical college hospital, Dhaka from January 2018 to December 2019 over a period of 2 years. Forty-seven patients who underwent loop transverse colostomy closure were included in this study. Patients were allocated by purposive sampling into two groups, group A (linear stapler anastomosis) and group B (hand-sewn anastomosis). Results: Mean age of the patients were 5.79±3.23 years and 4.21±3.13 years in linear stapler anastomosis group and hand-sewn anastomosis group respectively. Male to female ratio was 1.2:1 in linear stapler anastomosis group and 5.25:1 in hand-sewn anastomosis group. The mean duration of return of bowel movements (passage of flatus after surgery) in linear stapler method was 32.82±6.04 hours and in hand sewn method was 40.56±5.35 hours (p<0.05). Oral feeding was started earlier in patients who underwent linear stapler anastomosis (3.18±0.39 days), as compared to hand-sewn anastomosis (4.16±0.37 days) (p≤0.001). The mean cost in linear stapler method was Tk. 4072±158 and in hand sewn method was Tk. 1440±362. Anastomotic leakage was lower (4.5%) in linear stapler anastomosis than that in hand-sewn anastomosis (20.0%) (p>0.05). Conclusions: Stapling technique can be used safely and effectively as a part of modern Surgeon`s armory and one should be equally expert with stapler guns as with needle holders and sutures.

How Closure of Transverse Loop Colostomy is Performed in Russia.

Balaban, Vladimir M.D., Ph.D.1; Mutyk, Mikhail M.D.2; Tsarkov, Petr M.D., Ph.D.1 Author Information

Closure of Transverse Loop Colostomy.

Caiado, André M.D.1; Cabral, Francisco X. M.D.1; Barroca, Rita M.D.2 Author Information

SJLA_2024_A1: Appendix and Ascending Colon Intussusception through a Prolapsed Transverse Colostomy: A Case Report with Literature Review

Background: Stoma creation is one of the most common performed surgical procedures. For both benign and malignant conditions, in elective and emergency settings. Like any surgical procedure, it is associated with complications. One of the most frequently encountered is prolapse, with the incidence rate reaching 26%. On the other hand, intussusception of the bowel through the ostomy is a rare complication, with few cases being reported in the literature. Methods: The study was a case report. Results: We reported a case of a 52-year-old female with a proximal limb transverse loop colostomy prolapse noted 1 day before her presentation. Intraoperatively, cecal intussusception through the ostomy is encountered with unsalvageable right colon. The patient ended up with right hemicolectomy, end ileostomy, and mucus fistula. Discussion: Although stoma prolapse is a common late complication with an impact on quality of life in terms of difficulty with appliance fitting, it can be an early sign of a serious condition like intussusception. This necessitates a differentiation between intussusception through a prolapsed colostomy from simple prolapse. Based on literature, reduced stoma output along with significant irreducible prolapsed segment are the frequent clinical characteristics. Yet, it should be noted that the intussuscepted segment is only evident upon surgical exploration. Conclusion: Caution during stoma creation must be attempted, with the avoidance of underestimating a significant irreducible prolapse. As it may be lead to intussusception and subsequent bowel perforation.

Milk curd syndrome with goat's milk

Milk curd syndrome is an infrequent cause of intestinal obstruction in neonates and early infancy. We are adding to the literature an extremely rare case of milk curd syndrome in a 3-month-old infant who was being fed with goat's milk. A 3-month-old infant presented with features of intestinal obstruction. The patient used to pass a few pellets such as small, firm, white-colored stools after every 2 to 3 days often requiring enema. The baby was fed with goat's milk. Abdominal radiographs suggested large bowel obstruction. The conservative treatment with rectal washes failed. Exploration revealed dilated small bowel with the presence of very dense, inspissated, sticky, and white-colored intraluminal material in the terminal ileum and throughout the colon. Multiple attempts were made to milk the contents distally and finally out of the rectum but failed. A transverse loop colostomy was performed and inspissated milk curds were milked out. The outcome was favorable. The diagnosis of milk curd obstruction should be considered in neonates and infants with signs of the terminal ileum or large bowel obstruction fed with unmodified animal milk, for example, goat's milk (as seen in our case) or formula feeds.

Management and Outcomes among Acute Intestinal Obstruction Patients Admitted At Tertiary Care Institute of North India

Background: Acute intestinal obstruction continues to be one of the commonest surgical emergencies. Present study was done to evaluate the Management and outcomes among acute intestinal obstruction patients admitted at IGMC Shimla. Material and Methodology: This cross sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic Characteristics, Management and outcomes was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years .Mean age in our current study was 53 years and male to female ratio was 3:1. In our study patients of intestinal obstruction were managed more commonly surgically 30 (60%) than conservative 20 (40%). Among the 30 patients managed surgically, Adhesiolysis was done in 8 patients, Resection and anastomosis in 7 patients, Resection anastomosis and stoma creation in 5 patients, Hemicolectomy in 6 patients, Appendicectomy in 2 patients, Transverse loop Colostomy in 1 patient and De-rotation with sigmoidopexy in 1 patient. In the present study of 50 patients, 2 patients died. All death were due to Septicaemia and ARDS. Conclusion: Our study concluded that most of cases of Acute Intestinal Obstruction were managed surgically. Adhesiolysis, Resection and anastomosis, Resection anastomosis and stoma creation and Hemicolectomy were the common mode of surgical management. All death occurred due to Septicaemia and ARDS.

Loop ileostomy or loop transverse colostomy for resectable rectal cancers

Objectives: This retrospective study aimed to compare loop ileostomy (LI) with loop transverse colostomy (LTC) as covering stoma regarding the perioperative outcomes in patients who underwent low anterior resection for rectal cancer between 2015 and 2020. Methods: Data were collected from patient files and the hospital's electronic database. The primary outcome measure was complications related to stoma formation, stoma reversal, and overall complications. Secondary outcome measures were hospital discharge time and readmission rate after discharge. Results: A total of 90 patients (38 female, 52 male; 56.6 ± 6.8 years) were included in the study. There were two groups considering the technique for covering stoma: Group LI (n = 50) and Group LTC (n = 40). Demographic and perioperative characteristics were similar. Primary outcome measure: Postoperative course was complicated in 49 (54.4%) patients. The complication rate was higher in the group LI than the group LTC (62% vs 45%; p = 0.03). Among them, 29 (59.2%) complications were related to the stoma formation related, and 14 (28.6 %) complications were related to the stoma reversal related, and 6 (12.2%) were overall complications. The rate of complications related to the stoma formation was higher in the group LI compared to the group LTC (20 [40%] vs. 9 [22.5%]; p = 0.01). The most common complication was periostomal skin irritation (48.3%) followed by dehydration (13.8%), stoma retraction (10.3%) patients, parastomal hernia (10.3%), bleeding (6.9%), anastomotic leak (3.4%), incisional hernia (3.4%), and high-output stoma (3.4%). Complications including incisional hernia, high output stoma, and anastomotic leakage (Grade C; requiring laparotomy) were observed only in the group LI. The morbidity rate in 30 days after the surgery was higher in the group LI compared to the group LTC (16 [32%] vs. 8 [20%]; p = 0.02). A total of 14 stoma reversal complications included incisional hernia in 7 (14.3%) patients, wound infection in 5 (10.2%) patients, and rectal bleeding in 2 (4.1%) patients. The rate of complications was not different between groups (16% vs. 15%; p = 0.41). Overall complications were similar between study groups (3 complications in each group; p = 0.73). Secondary outcome measure: The group LTC patients were discharged earlier compared to the group LI (7.1 ± 2.0 days vs. 9.4 ± 2.5 days; p = 0.03). The readmission rate after hospital discharge was higher in the LI group than the group LTC (18% vs. 12.5%; p = 0.02). Conclusions: It was concluded that LTC was superior compared to LI concerning complications after low anterior resection for rectum cancer.

Disseminated Melioidosis presenting as pneumonia, femoral and sacral osteomyelitis, splenic abscess and high rectal fistula: A case report and review of literature.

IntroductionMelioidosis is a rare infectious tropical disease caused by Burkholderia pseudomallei (B. pseudomallei), an environmental saprophyte usually habitating on soils of Southeast Asian fields. Most of the reported cases present with pneumonia and intra-abdominal abscess. Diagnosis is established by culture studies from the blood, sputum or abscess drainage. Management relies on culture-guided antibiotic treatment, with good prognosis. Surgical intervention is required in cases not responsive to medical management.Presentation of caseWe are presenting a case of Melioidosis in a 72 year old Filipino who presented with Pneumonia, Femoral and Sacral Osteomyelitis, Splenic Abscess and High Rectal Fistula. He was successfully managed with systemic antibiotic treatment and surgery. The splenic abscess was managed by splenectomy and a transverse loop colostomy was used for fecal diversion to address the rectal fistula.DiscussionMelioidosis varies in its presentation and thus management should be individualized, depending on the organs involved. Our patient presented with multiple foci of infection which rendered the treatment more complicated as compared to those reported previously in published literature. The pneumonia and the osteomyelitis were managed with aggressive systemic antibiotics but the other sites of infection required drainage and surgery.ConclusionMelioidosis is a rare infection caused by an environmental saprophyte Burkholderia pseudomallei. An accurate diagnosis using culture studies is essential to institute appropriate treatment. Antibiotic treatment complemented by surgery for specific organ involvement is essential for cure.

THORACOABDOMINAL AORTIC DISSECTION: ATYPICAL PRESENTATION AND MULTIORGAN DAMAGE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute Aortic Dissection (AoD) is the disruption of the tunica intima and tunica media of the aortic wall forming a blood-filled dissection plane dividing into "true" and "false" lumen. We categorize AoD as Type A and Type B (Stanford classification) based on the part of the aorta involved. However, an accurate diagnosis is difficult due to inconsistent clinical presentations (typically present with tearing chest pain radiating to the back). This is a unique clinical case of an atypical presentation with a complicated clinical course. CASE PRESENTATION: A 53-year-old man with untreated hypertension presented to the emergency room (ER) with worsening right lower extremity (RLE) pain and numbness for 6 days, aggravated with ambulation along with right lower quadrant (RLQ) abdominal pain. He endorses extensive tobacco, alcohol, marijuana, and cocaine use. In the ER, the blood pressure was 275/142 mmHg, biventricular hypertrophy on the EKG. He also had RLQ tenderness and diminished pulses in the RLE. The abdominal computed tomography (CT) discovered a distal abdominal aortic division. The larger false lumen dissected the left renal artery, left common iliac artery, with thrombosis of the left internal iliac artery. The narrow true lumen minimizes perfusion to the RLE and the right kidney. CT angiography of the chest confirmed a Stanford Type B aortic dissection with the intimal tear distal to the left subclavian artery. Intravenous Nicardipine and Esmolol drip controlled the blood pressure, followed by a femorofemoral bypass to improve RLE perfusion. Post-operative contrast nephropathy improved on day 10. Subsequently, a persistent ileus due to poor intestinal perfusion was corrected by transverse loop colostomy on day 15. On day 20, the patient was discharged with oral antihypertensive medications. DISCUSSION: The incidence of AoD is 5-30 per million people per year. 38% of ER presentations are missed; 28% are diagnosed at autopsy. Hypertension, atherosclerosis, cocaine abuse, cardiac surgeries, and systemic inflammatory syndromes can increase risk. Sullivan et al. suggest that a physician suspects AoD in 86% of patients with chest and back pain, 45% with only chest pain, and only 8% with abdominal pain. Our case is a unique combination of an atypical presentation (abdominal pain, leg numbness) with significant malperfusion of RLE, small bowel, and the right kidney (IRAD registry). For Type B dissection, medical management is preferred followed by surgical techniques to improve perfusion. Estimated inpatient mortality is 30% in proximal dissection and 10% in distal dissection. After the acute phase, the 10-year survival rate for AoD is <50%. CONCLUSIONS: Even with atypical symptoms, AoD and associated complications were successfully diagnosed and treated. Even with current surgical and medical advancements, controversies regarding diagnosis, the timing of repair, and type of repair still exist. REFERENCE #1: Cebicci, Huseyin & Salt, Omer & Gurbuz, Sukru & Sahin, Taner & Cumaoglu, Mustafa & Koyuncu, Serhat. (2014). Atypical presentations of aortic dissections: A case series. Acta Medica Mediterranea. 30. 85-90. REFERENCE #2: Sullivan PR, Wolfson AB, Leckey RD, Burke JL. Diagnosis of acute thoracic aortic dissection in the emergency department. Am J Emerg Med. 2000 Jan;18(1):46-50. doi: 10.1016/s0735- 6757(00)90047-0. PMID: 10674531 REFERENCE #3: Crawford, Todd C, et al. "Malperfusion Syndromes in Aortic Dissections." Vascular Medicine, vol. 21, no. 3, 2016, pp. 264–273., doi:10.1177/1358863x15625371 DISCLOSURES: No relevant relationships by Saurabh Chokshi, source=Web Response No relevant relationships by David Goldgrab, source=Web Response No relevant relationships by Devansh Patel, source=Web Response no disclosure on file for Jorge Perez

The Surgical Correction of Hirschsprung’s Disease in Adults Using the Modified Duhamel Procedure

Background: Hirschsprung’s disease (HD) is rare in adults, since a majority of cases are corrected in childhood. Objectives: The authors describe the profile of patients with HD who reached adulthood without having undergone corrective surgery. Also, they describe the outcomes of a modified Duhamel procedure in these patients, in terms of morbidity and mortality. Methods: This retrospective study, included patients 18 years old and above, diagnosed with HD who reached adulthood without having undergone definitive repair and managed surgically by the Division of Colorectal Surgery, UP-PGH from January 1, 2004 to December 31, 2014. A review from the Department Surgical Database was used and patients’ hospital records were used to fill out a Data Collection Form. Descriptive statistics were used to summarize the data. Results: The 13 patients included in the study were diagnosed at an average age of 16.6 (± 13.16) years. The mean age at the time of definitive surgery was 23.46 (± 6.96) years. The M:F ratio was 5.5:1. The most common presenting symptom was constipation (69.23%). All had a prior proximal bowel diversion, with a transverse loop colostomy (61.54%) being the most common. The transition zone was located in the sigmoid in a third of patients. The mean time from diagnosis to definitive surgery was 6.69 years. Eight (61.54%) have since undergone stoma reversal. There was only one (7.69%) morbidity, a superficial surgical site infection. No mortalities were reported. Conclusion: The modified Duhamel procedure is a safe definitive surgical procedure for the adult patient with HD. Key words: adult Hirschsprung’s disease, colostomy, Modified Duhamel procedure

Analysis of Situation and Pattern of Diseases of the Neonates Admitted in Department of Pediatric Surgery of a Medical College Hospital

Background: Neonatal surgery (NS) is an extremely challenging leading edge of pediatric surgery. In our country NS death were 8% due to treatable congenital anomalies. The objectives of study were to observe yearly admission of NS patients, age of presentation, anthropometric records, prenatal record and types of congenital anomalies, and mortality of treated neonates.&#x0D; Materials and Methods: This cross-sectional study was conducted on 337 admitted neonates to assess the state of 70 consecutive NS patients admitted in the Pediatric Surgery ward. Birth weight was compared with randomly selected and sex matched 154 were neonatology neonates (NN), and 113 delivered un-admitted healthy neonates of the labor-ward (LN). The variables observed were number of neonatal surgical patients admitted, age of presentation, birth and admission weight, prenatal ultrasonogram for fetal anomalies and the types of anomalies, outcome (mortality) of neonatal surgery.&#x0D; Results: The mean age of surgical neonates at the time of admission was 5.7 ± 6.39 (1-25) days. Mean birth weight of surgical and neonatology neonates was 2.66 ± 0.76 (1.5-4.5) kg and 2.24 ± 0.71 (0.9-4) kg respectively. The difference was significant (p &lt; 0.01). The mean admission weight of the surgical and neonatology neonates were 2.57 ± 0.66 (1.4-4.1) kg and 2.25 ± 0.62 (0.8-4.1) kg respectively showing significant difference (p &lt; 0.01). Ten percent of NS patients and 38.3% of NN patients had records of prenatal ultrasonogram, and their reports were normal fetus. The difference was significant (Z = 4.36). Eighty seven percent NS patients and 49% NNs were delivered at home and the difference was significant (Z = 4.49). Major surgical problem were anorectal malformation (48.6%) and neonatal intestinal obstruction (20%). The treatments given to the patient admitted in the pediatric surgery ward were emergency laparotomy with resection-anastomosis, ileostomy, and transverse loop colostomy in 29 (41.3%), anoplasty 21 (30%), incision and drainage of abscess 5 (7.1%), and conservative treatment 15 (21.43%). The mortality rate of neonatal surgical and neonatology patients was 12.9% and 13% respectively.&#x0D; Conclusion: The number of NS patients (work load) indicated the necessity of establishment of a NS unit which could be viable. The mortality of NS patients were due to low birth weight, and delivery at home causing transport delay from birth place to the pediatric surgery ward because of lack of prenatal awareness of presence of congenital anomalies. Anorectal malformation is the commonest congenital anomaly, followed by neonatal intestinal obstruction. Emergency laparotomy was the major surgical intervention offered. To improve the survival of the NS patients, prenatal diagnosis of the congenital anomaly, mandatory delivery at defined hospital, rapid transport of the surgical neonates born away from hospital, and establishment of a NS unit in tertiary level hospitals were indicated.&#x0D; Journal of Surgical Sciences (2020) Vol. 24 (1) : 26-31

Acute Large Bowel Obstruction Following Late Sequelae of Traumatic Diaphragmatic Hernia

A 33 years old patient was admitted in a Military Hospital with the features of acute large gut obstruction. Exploratory laparotomy was done and peroperatively the obstruction was seen in the transverse colon and obstruction seemed to be carcinoma of transverse colon with involvement of left hemidiaphragm which was not negotiable. Transverse loop colostomy with decompression of bowel was done. Subsequently the patient was transferred to tertiary level hospital in Dhaka. In the tertiary hospital, the patient developed left sided massive pleural effusion. With relevant investigation the condition was diagnosed as left sided diaphragmatic hernia. Thoracotomy was done and herniorrhophy was performed after reduction of the content. Post-operative management was stormy and eventful but the condition improved gradually and the patient was discharged in proper time. The patient had history of chest trauma due to RTA he met 4 years back and he received hospital indoor management for 3½ months. The patient was asymptomatic and leading normal active military life before 2nd time admission for acute intestinal obstruction. The patient had past history of trauma to left chest wall 4 years back, presented with acute large gut obstruction and there was diagnostic dilemma. There were management difficulties and post operative events were stormy. The aim of this reporting is to highlight all of these.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 119-120

Indocyanine green fluorescence during pediatric stoma closure

Abstract In this paper, we discuss the first two cases who underwent colostomy closure using ICG fluorescence system (Stryker, PINPOINT System®). Case 1 11-months-old female with 21 trisomy and anorectal malformation (rectal atresia without fistula). She had sigmoid loop colostomy in neonatal period and Posterior Sagittal Anorectoplasty (PSARP) in 9 months of life. During the colostomy closure, ICG was intravenously administered to evaluate blood flow of anastomotic site. Twenty-two hours after operation, she had the first defecation which was positive for ICG fluorescence. Case 2 16-months old male with postoperative state of tracheoesophageal fistula and rectovestivular fistula. He had transverse loop colostomy in neonatal period and PSARP in 12 months of life. During the colostomy closure, ICG was intravenously administered to evaluate blood flow of anastomotic site. Twenty-five hours after operation, he had the first defecation which was negative for ICG fluorescence. Forty hours after operation, he had ICG-positive defecation. There were no postoperative complications for both of patients. ICG fluorescence system has two merits for pediatric colostomy closure evaluation of anastomotic blood flow and postoperative bowel function.

A Prospective Study of Intestinal Stomas

Background and Objectives: Intestinal stomas are commonly constructed in an emergency as well as elective setting for a variety of indications. Historically associated with a high morbidity, evolution of skills on the part of the surgeon has lead to better understanding of the indications, complications and management of a stoma. This study aims to evaluate the above mentioned parameters and hence improve the outcome of patients undergoing a stoma. Method 50 patients admitted in MMIMSR, Mullana (Ambala) and later operated and managed with a stoma were closely followed up from the date of admission to the date of discharge and the various parameters were studied. Results The indications, technique, complications and its management were studied in detail by following patients in person or through phone and the results were analyzed in detail. Interpretation and Conclusion Construction and management of stoma was associated with a few complications. Most patients however tolerated the procedure well and the overall compliance was satisfactory. Loop ileostomy was the commonly constructed stoma and the one associated with most complications. Transverse loop colostomy was associated with no complications and was extremely well tolerated.

Sigmoid Volvulus in a Neonate with Anorectal Malformation: A Case Report

Background: Sigmoid volvulus in the neonate is an extremely rare condition needing emergency treatment. Sporadic cases of neonatal sigmoid volvulus and some in association with Hirschsprung’s disease have been documented. Sigmoid volvulus has been described only twice in the literature in association with anorectal malformation. However, newborns with anorectal malformations might be especially at risk for sigmoid volvulus due to increased intraluminal intestinal weight caused by bowel obstruction and its existence might be underreported. Case presentation: This is the case report of a full-term neonate with trisomy 21 who was diagnosed with anorectal malformation upon birth. An abdominal X-ray on his second day of life showed typical radiological findings of sigmoid volvulus as described by the radiologist. However, the findings were interpreted as a dilated rectosigmoid sling typical for anorectal malformation by the surgeon and a transverse loop colostomy was placed. On the fourth postoperative day sigmoid perforation occurred and led to meconium peritonitis and septic shock. An emergency laparotomy was performed and a perforation at the distal sigmoid colon was found. Conclusion: There is an urgent need to raise awareness as to the existence of sigmoid volvulus in the neonate with anorectal malformations. The distinct radiological findings of the “coffee bean sign”, the “northern exposure sign” and an empty rectum allow to distinguish the extremely rare sigmoid volvulus from the common finding of a dilated rectosigmoid in patients with anorectal malformations. Detorsion of sigmoid volvulus is vital to preventing sigmoid perforation.