Transverse Loop Colostomy Research Articles

P-0236 Indications and Outcomes after Laparoscopic Stoma Creation: The Philippine General Hospital Experience

ABSTRACT Introduction Fecal diversion through an open surgical approach is associated with considerable trauma, stress, and post-operative pain. Laparoscopic stoma creation, on the other hand, has been widely documented to decrease post-operative pain, to reduce adynamic ileus, to hasten post-operative feeding, to improve recovery and to induce earlier commencement of neoadjuvant treatment for patients with locally-advanced rectal cancer. This study aims to describe and evaluate cases of laparoscopic stoma creation in terms of indication, post-operative outcome, length of hospital stay, morbidity and mortality. Methods This is a descriptive, retrospective study. All adult patients admitted by the Division of Colorectal Surgery at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 01, 2007 to December 31, 2011 who underwent laparoscopic stoma creation were included in the study. Results Fifty-one patients underwent laparoscopic stoma creation from 2007 to 2011. Mean operation time was 80 minutes (SD: -20 to 25 minutes). The most common indication was for locally-advanced, obstructing colorectal cancer (88.23%, 45/51). Transverse loop colostomy was the most common type of surgery (65.66%, 34/51). There was only one conversion. Two patients were re-operated on for stoma prolapse, translating to a morbidity rate of 3.92%. No procedure-related mortality was documented. Patients were discharged after two to fifteen days post-operatively (mean 5.54 days). Conclusion Laparoscopic stoma creation is a safe and short surgical procedure with low morbidity and mortality rates.

Surgery after Colonic Stenting

Colonic stenting is an accepted treatment of large bowel obstruction. The literature is sparse regarding surgical difficulties associated with an indwelling stent. We report our experience focusing on outcomes, complications, and whether the stent created intraoperative concerns. In this retrospective review, 6 patients were identified between 2007 and 2010 that had surgery after colonic stents were placed. Their charts were reviewed to compare clinical variables, surgical procedures, outcomes, and complications. One obstruction was due to diverticulitis. The stent reobstructed, leading to emergent transverse loop colostomy, and subsequent sigmoidectomy with stoma reversal. Four patients' obstructing masses were malignant. The final patient's stent was placed through a Hartmann's stump to drain a pelvic abscess. These 5 patients had no stent complications. Surgery occurred an average of 9.8 weeks after stent placement; four had low anterior resections and one underwent Hartmann's reversal. All 6 patients had colorectal anastomoses and five underwent laparoscopic surgery; one had an anastomotic leak requiring reoperation. Colonic stenting allows for the immediate relief of obstruction while permitting diagnosis and treatment of coexisting medical problems. The colon can be prepared for an elective rather than emergency operation, and a colostomy may be avoided.

An unusual case of small intestine evisceration through a transverse loop colostomy

Colorectal DiseaseVolume 14, Issue 1 p. e27-e28 Case report An unusual case of small intestine evisceration through a transverse loop colostomy M. Villa, M. Villa Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorE. Iannelli, E. Iannelli Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorM. Grande, M. Grande Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorP. Rossi, P. Rossi Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorG. Tucci, G. Tucci Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this author M. Villa, M. Villa Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorE. Iannelli, E. Iannelli Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorM. Grande, M. Grande Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorP. Rossi, P. Rossi Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this authorG. Tucci, G. Tucci Department of Surgery, Tor Vergata University Hospital, Rome, ItalySearch for more papers by this author First published: 05 August 2011 https://doi.org/10.1111/j.1463-1318.2011.02749.xCitations: 4 Dr Massimo Villa, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy. E-mail: villamassimo@inwind.it Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume14, Issue1January 2012Pages e27-e28 RelatedInformation

Diverticulitis complicated by pylephlebitis: a case report

IntroductionPylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. In the current report, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis.Case presentationA 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy. A peritoneal fluid sample culture grew Escherichia coli. Our patient had an uneventful post-operative course and the leukocytosis resolved in the next four days. She improved clinically and was discharged home on ertapenem and enoxaparin. A follow-up computed tomography scan two weeks later showed a new pelvic abscess that was drained by a pigtail catheter but there was no change in the portal venous thrombus. A repeat computed tomography scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus, for which enoxaparin was continued.ConclusionsThis is a classic case of pylephlebitis that demonstrates the importance of recognizing that the portal vein thrombus is infected and treating the condition appropriately.

Endoscopic management of complete colonic obstruction.

A patient with metastatic rectal cancer underwent a diverting transverse loop colostomy due to rectal obstruction. 16 months later, he underwent a low anterior resection to resect his rectal cancer along with reversal of his transverse colostomy, and creation of a temporary loop ileostomy. Six months later, he was brought to the operating room for closure of his ileostomy. Post-operatively, the patient developed nausea, vomiting, and abdominal distention and imaging revealed a large bowel obstruction, confirmed by colonoscopy. The patient refused surgical diversion and a cecostomy tube was placed for decompression. After maturation of the cecostomy fistula, a rendezvous colonoscopy was performed, retrograde through the rectum and antegrade through the cecostomy fistula. The obstructing mucosa was traversed and the site of obstruction was balloon dilated, relieving the obstruction endoscopically.

Functional colonic obstruction in an adult as a presenting feature of thymoma

Functional colonic obstruction is a colonic motility disorder with a number of causes. One cause is myenteric ganglionitis, which may result from paraneoplastic processes. We present the case of a previously healthy 53-year-old man who presented with a week's history of functional colonic obstruction. A transverse loop colostomy failed to resolve his symptoms and he subsequently underwent an extended right hemicolectomy. Histology demonstrated lymphocytic myenteric ganglionitis that was felt to be of paraneoplastic origin. The patient later developed bilateral ptosis and was diagnosed with ocular myasthenia gravis. Further investigation revealed the presence of a thymoma that was resected, resulting in an improvement to his symptoms. We present this case and a review of the literature to illustrate the importance of seeking out a paraneoplastic cause for functional colonic obstruction in adults as early resection of the tumour may help alleviate symptoms and avoid bowel surgery.

Experiences with childhood colostomy at a tertiary hospital in Mwanza, Tanzania

Colostomy is a common life saving procedure in children and may be attended by significant morbidity. This cross-sectional study was carried out to describe experiences with childhood colostomy outlining the common indications, complications and their management and to identify factors associated with these complications in a tertiary hospital in Mwanza, Tanzania. Data was collected using a pre-tested, coded questionnaire. A total of 134 patients were studied. Seventy-eight (58.2%) were males and females were fifty-six (41.8%) (M: F =1.4:1). Their mean age was 1.83 years (range 1 day to 10 years). Anorectal malformations and Hirschsprung’s disease were the most common indications for colostomy formation in 46.3% and 40.3%, respectively. Transverse loop colostomy was the commonest type of colostomy performed accounting for 79.1% of cases. Colostomy-related complications were recorded in 35.8% of cases. Skin excoriation and colostomy prolapse were the most common complications accounting for 19.4% and 17.9% respectively. The overall complication rate was significantly common in transverse colostomy than in sigmoid colostomy and in colostomies performed by junior doctors (P

Anal avulsion caused by abdominal crush injury

We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations. An emergency laparotomy was performed with debridment, urethral reconstruction, and osteosynthesis of the pubic bone. The mobilization of the patient revealed a deep gap, about 8×8cm, in the perineum, with the anus and rectum displaced from their original site. Anal reimplantation was performed, suturing the median raphe, inserting two pelvic drainage tubes, and fashioning a loop transverse colostomy. Closed rectal traumas account for only 4-11% of all rectal traumas. Crushing of the pelvis causes a sudden reduction in its anteroposterior diameter and a corresponding increase in its latero-lateral diameter, together with an abrupt rise in intra-abdominal pressure. The anus is pushed out of the perineal plane due to the divarication of the levator muscles. As suggested in the literature, the standard treatment is wound debridement with immediate or deferred repair, fashioning a diversion colostomy, and repair of the rectum, wherever possible.

Diversion stoma after colorectal surgery: loop colostomy or ileostomy?

The total rate as well as the clinical outcome of anastomotic leakage in colorectal and coloanal anastomosis necessitates a loop stoma for fecal diversion. The aim of this study was to determine the outcome of loop transverse colostomy compared to loop ileostomy as a temporary defunctioning stoma following colorectal surgery with colorectal or coloanal anastomosis. Data of 200 patients between January 2003 and January 2009 were analyzed in this two-center study to determine the surgical outcome in patients with loop colostomy (n = 100) in comparison to loop ileostomy (n = 100) for fecal diversion including outcome of stoma creation and complication rates during stoma reversal. During stoma placement, dermatitis and renal insufficiency occurred significantly more often in the loop ileostomy group than in the loop transverse colostomy group (15% vs. 0%; p < 0.001 and 10% vs. 1%; p = 0.005). During stoma reversal, wound infection occurred significantly more often in the loop transverse colostomy group than in the loop ileostomy group (27% vs. 8%; p < 0.001). Time to first defecation was significantly shorter in the loop ileostomy group after both placement and reversal (4 ± 2 vs. 2 ± 1; p < 0.001 and 3 ± 2 vs. 2 ± 1; p < 0.001). Hospital stay was significantly shorter in the loop ileostomy group than in the loop transverse colostomy group after stoma closure (18 ± 15 vs. 13 ± 6; p < 0.001). Both methods provide a good operative outcome with low complication rates. We do recommend the loop ileostomy in all patients in which dehydration is not to be expected since wound infection rate is lower and hospital stay is shorter during stoma reversal.

Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria

Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pull through (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05). There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.

Technical Points Regarding New Enterostomy Formation for Incarcerated Stomal Prolapse in Loop Enterostomy

Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.

An overview of stoma bridges and a case study on their management

Over recent years, very little appears to have been written on stoma bridges or rods, which are additional supportive mechanisms for loop stomas. Within St Mary's NHS Trust, bridges are commonly used following the construction of a loop stoma (ileostomy, colostomy, and loop transverse colostomy), and the author has become accustomed to their presence. However, in conversing with other stoma care nurses across the country, it has become apparent that not all institutes, trusts, or other hospitals use bridges, and it would seem that some have not done so for many years. Intrigued by these devices, the author decided to take a closer look at their use, appearance and purpose. This will provide other stoma care nurses, as well as general nurses, with a better understanding of what they are and why some surgeons still use them. A short case study is also presented, discussing how a bridge was managed in the post-operative period when an appliance became insecure and the bridge was immobile and tight against the abdominal surface/plane.

Sp276: Endoscopic Rendezvous for Complete Colonic Obstruction

A 50 year old man with metastatic rectal cancer to the liver underwent a diverting transverse loop colostomy due to rectal obstruction. The patient requested resection of his rectal tumor due to difficulty managing his ostomy because of congenital blindness. Sixteen months after his previous surgery, he underwent a low anterior resection, reversal of his transverse colostomy, and creation of a temporary loop ileostomy. Six months later, prior to his ileostomy takedown, a barium enema showed a widely patent rectal anastomosis. The patient was brought to the operating room for closure of his ileostomy. On post-operative day four, the patient developed nausea, vomiting, and abdominal distention. Abdominal imaging revealed a large bowel obstruction. A colonoscopy revealed an obstruction at the previous transverse colostomy site. The patient declined surgical diversion due to difficulty caring for his previous ostomy.

Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall

BackroundSigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall.Case presentationA 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0) sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided.ConclusionMetachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.

Loop ileostomy versus loop transverse colostomy for temporary fecal diversion after colorectal anastomosis

Background: Leakage from low colorectal anastomosis could be reduced by using covering stoma to divert fecal stream. Controversy is still present as to whether loop ileostomy (LI) or loop transverse colostomy (LTC) is the optimal method of defunctioning such anastomosis. Methods: Patients requiring defunctioning following anterior resection or emergency left colonic resection were randomized to receive either LI or LTC. Comparison was made between both groups regarding efficacy & complications. The minimum follow up after stoma closure was 3 months (mean 10 months). Results: Between January 2007 and April 2009, 62 patients were randomized into 2 groups (LI 32, LTC 30). There were no significant differences in the mortality, postoperative leakage, stoma prolapse, parastomal hernia, parastomal fistula, incisional hernia, postoperative bowel obstruction, or skin irritation. However, there were significant difference in favour of LI including less evidence of wound infection, less hospital stay, less stomal retraction or necrosis, less time for creation of stoma, less time of bowel transiet and better patient adaptation, while dehydration and time of closure was in favour of LTC. Conclusion: In this randomized study, both methods appear to provide satisfactory protection method for the low colorectal anastomosis, but LI in general was associated with little complications specially wound infection & stoma related complications, which favours it as a covering stoma.

Bone Marrow Necrosis Caused by Metastatic Colon Cancer

A 37-year-old man presented to our clinic complaining of bloody stool passage over the previous week. Colonoscopy found a mass over the sigmoid colon, and a biopsy disclosed adenocarcinoma. A hemogram revealed anemia and thrombocytopenia. Low anterior resection and transverse loop colostomy were performed after aggressive platelet transfusion. Blood clots passed from the colostomy persistently after the surgery. Laboratory data revealed elevated concentration of D-dimer (6562 ng/mL), progressive anemia, and profound thrombocytopenia (19,000/ L) 6 days after the operation. The patient complained of regional soreness and pain over the long bone area. A whole-body bone scan revealed inconclusive bony metastasis. The histological findings of a bone marrow biopsy revealed extensive marrow necrosis with few surviving cancer cells (Fig 1A). The cancer cells stained positively for p53 (Fig 1B, arrows). The patient was treated with cetuximab plus oxaliplatin, fluorouracil, and leucovorin. During the first month after the start of treatment, the passage of blood clots decreased gradually and the platelet count returned to normal. Despite treatment, the patient died of disease progression 3 months later. Bone marrow necrosis is a syndrome first reported by Wade and Stevenson in 1941. The typical findings are necrosis of myeloid tissue and medullary stroma leaving an amorphous eosinophilic background, ill-defined necrotic cells, and preserved cortical bone. The pathophysiology of bone marrow necrosis is still unclear. Failure of the microcirculation accompanied by hypoxemia causes damage to the cells. The toxicity and the release of toxins, cytokines, or vasoactive substances from the injured cells play an important role in the pathophysiology of bone marrow necrosis. The incidence of bone marrow necrosis is low. It has been reported in association with infection, sickle-cell anemia, hematological malignancy, and solid tumors. Hematological malignancy is the most common cause of the bone marrow necrosis. The prognosis in patients with bone marrow necrosis is poor. Most patients presented with symptoms of bone pain, fever, and fatigue. Laboratory tests usually disclose anemia and thrombocytopenia. Both bone x-rays and bone scans are usually normal, except in patients with metastatic disease. Colon cancer with bone marrow necrosis had rarely been reported before. Here we reported a case of colon cancer presenting with bone marrow necrosis. The patient died despite aggressive chemotherapy. To conclude, bone marrow necrosis is a rare entity and has a poor prognosis.

Unusual hernia in a colostomy closure site

This is a case report of an interstitial hernia following previous transverse loop colostomy closure. There are no reported cases in the literature of gangrenous gall-bladder as the content of an interstitial hernia. This condition can present as a diagnostic challenge. We present a case with a previous reversal of a colostomy in the right upper quadrant presenting with a short history of a right iliac fossa mass and tenderness. Clinically, the patient was septic without any peritonitis. Subsequent computed tomography scan suggested the hernial sac contained gall-bladder and loops of bowel. At surgery, a gangrenous gall-bladder was found within an interstitial incisional hernia (between the external and internal oblique muscle). Retrograde cholecystectomy was performed and bowel and hernia were reduced. The hernia was repaired in layers and patient had an uneventful recovery.

Sigmoid Volvulus in an Atypical Patient: A Letter to the Editor/Case report

A previously healthy 20-year-old male presents with a several week history of recurrent, sudden onset abdominal distention, obstipation and emesis. He reports that previous episodes resolved spontaneously and he did not seek medical attention. On this occasion, his symptoms regressed while in the Emergency Department. His clinical examination, blood work and abdominal radiographs were unremarkable. Upon being transferred to the Radiology Department for an abdominal CT scan, the patient developed a recurrence of his symptoms with significant abdominal distention. The CT demonstrated a dramatic ‘bent inner tube' or ‘omega sign' (Figure 1) and the characteristic mesenteric ‘whorl' (Figure 2, arrow) of sigmoid volvulus. The patient underwent successful decompressive flexible sigmoidoscopy. He initially refused operative intervention and was discharged. The patient soon returned with recurrent volvulus that was again decompressed and followed by sigmoid colectomy on the same admission. Unfortunately, the patient developed an anastamotic leak in the first postoperative week. This was treated with exploration, suture repair of the leak, and diverting loop transverse colostomy. The patient recovered from this procedure and was well at two-months follow-up. He will be scheduled for elective closure of his colostomy in the near future.

Endoscopic Management of Complete Colonic Anastomotic Strictures Using Antegrade-Retrograde Rendezvous Technique. a Report of Two Cases

Purpose: Describe two cases of complete colo-colonic anastomotic stricture that were managed endoscopically using the antegrade-retrograde rendezvous technique. Methods: A 30 year old male with a loop ileostomy and colo-colonic anastomosis in the rectum. Routine BE 4 months later revealed a complete anastomotic stricture at 12 cm from the anal verge. This was confirmed endoscopically. A colonoscope was inserted through the ileostomy site and advanced to the colonic anastomotic obstruction. A second colonoscope was then inserted through the anus and advanced to the distal aspect of the stricture. Under fluoroscopic and endoscopic guidance a 0.021 wire was placed using a 19G Wilson Cook EUS needle, placed through the channel of the retrograde colonoscope, connecting the proximal and distal segment of the anastomosis. Over the wire, dilation of the tract was performed using graduated dilatation using a 4 mm to 15 mm TTS balloon. Two further sessions were required to enable loop ileostomy closure (surgery). An additional patient, a 57 year old female underwent low anterior resection and chemotherapy for a T3N1 rectal cancer. She subsequently developed a complete benign obstruction (stricture) at the anastomosis resulting in a transverse loop colostomy. This stricture was not able to be traversed and as described above the same rendezvous procedure using two colonoscopes under fluoroscopic guidance was successfully performed. Three subsequent endoscopic dilation were required prior to surgical closure of the colostomy. Results: The two patients described above had successful endoscopic management of complete colonic obstruction with recanalization of the anastomosis without the need for an extensive surgery. Both patients had an 18 months follow up with no recurrence of the stricture. Conclusion: This endoscopic rendezvous technique obviates the need for surgical management in benign complete anastomotic strictures in the rectum when an ileostomy or colostomy access is present.

Temporary Diverting Colostomy for Patients with Extensive Perineal Burns

Extensive perineal burn is uncommon in clinical cases. Burn in closed proximity to the anus poses difficult wound care and high graft failure rate. This paper reports the use of temporary colostomy for fecal passage diversion in treating two burn patients who suffered from 48% and 36% flame burn respectively. The injuries were resulted from suicidal attempts and the perineum burns were less than 2cm from the anus. Loop transverse colostomies were performed in the early stage of treatment and were closed following complete wound closure and when no late perineum scar surgery was anticipated. We advocate the used of temporary colostomy in the treatment of extensive deep perineum burn as continuous fecal soiling to the wound will delay wound healing and increase the risk of graft failure.