Transverse Loop Colostomy Research Articles

Abdominal Compartment Syndrome with Massive Lower-Extremity Edema Caused by Colonic Obstruction and Distention

Abdominal compartment syndrome is a well-described condition in which increased intraabdominal pressure causes various physiologic derangements with adverse effects on cardiac, pulmonary, and renal function. A patient presented with radiation-induced distal colonic obstruction, abdominal distention, and severe bilateral leg edema. We performed a diverting transverse loop colostomy as treatment for her obstruction. This resulted in massive, spontaneous diuresis with complete resolution of her lower-limb edema. Abdominal compartment syndrome due to colonic obstruction can contribute to the development of lower-extremity edema. Colon decompression with reduction of intra-abdominal pressure can lead to resolution of edema in this situation.

Colostomy complications — a surgical failure or a population problem

Stoma related complications vary from population to population. This study was undertaken in order to compare the complications associated with the most frequently constructed stomata at King Faisal Specialist Hospital (loop transverse, loop sigmoid and end colostomy) and those previously reported by one of the authors from a different population in New Zealand. Diverting stomata were of the dependant loop type. All operations were performed by or under the supervision of the same surgeon. One hundred and forty-one colonic stomata were fashioned in 137 patients (72 men, 65 women). There were 74 end stomata, 60 loop transverse and 7 loop sigmoid colostomies. One hundred and twenty-seven stomata were fashioned electively and 14 were constructed as emergencies. One patient died post operatively from overwhelming sepsis following colonic perforation. Follow-up varied from 1 to 72 months and most complications occurred within the first 6 months. The overall stoma complication rate was 22.7%. The complication rate was highest in patients in whom a loop transverse colostomy was performed. Stoma related complications were fewer in males than females (18.9% vs. 26.9%) and higher in patients having an emergency rather than an elective stomata (35.7% vs. 21.3%) although these differences did not reach statistical significance. Patients with stomata and early (Dukes Stage A and B) cancer had fewer stoma related complications (15.7%) than more advanced patients (25%). These differences were not statistically significant either. The overall stoma related complication rate in the New Zealand study was 11.1% and this was significantly different from the rate recorded in the present study (p<0.01).

Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon.

Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12 h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9.8 days. Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage.

Combined radical retropubic prostatectomy and rectal resection

Objectives. To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. Methods. Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. Results. All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. Conclusions. Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

Perineal hemangioma, anorectal malformation, and genital anomaly: A new association?

Two patients presented as full-term baby girls with anorectal and genital malformations with extensive perineal hemangiomas. The first patient had a vestibular anus with a perineal hemangioma involving the bladder, rectal, and vaginal walls. Skin ulcerations required a transverse loop colostomy for wound care. The vulva, urethral opening, and clitoris were deviated to the left, labia minora were absent, and the labia majora were abnormal. The second patient had an anus displaced anteriorly and deviated to the right. The external anal sphincter was hypertrophic on the left and atrophic on the right. Rectal examination showed agenesis of the right levator ani and a dentate line located at the skin level. She had a large perineal, sacral, vaginal, pararectal and retroperitoneal hemangioma and developed extensive skin ulcerations. She had only a hemiclitoris located to the left of the midline, near absence of labia minora, and hypertrophied labia majora. The urethra was displaced to the left and opened in the vestibule. Both patients had a spinal malformation (one with tethered cord and one with spina bifida) and a normal karyotype. Steroids and interferon allowed nearcomplete resolution of hemangiomas in both patients. The authors were impressed by the similarity of these two cases and could not find any previous description of this association.

Non-Prolapsing Total Defunctioning Transverse Loop Colostomy

Transverse loop colostomy is a simple procedure in it construction and closure. Prolapsed is a common complication of this procedure. Occasionally, total defunctioning may not be achieved with loop colostomy. In the present study, a simple modification of loop transverse colostomy which is prolapsed free and gives total defunction is described.

Protective transverse loop colostomy associated with low colo-rectal anastomoses.

A transverse loop colostomy to protect a low colorectal anastomosis should be carried out with minimal morbidity and mortality related to its creation and closure. A modification of the conventional technique is described.

Severe Radiation Injury to the Sigmoid Colon

We report our experience with the surgical management of severe radiation injury to the rectosigmoid colon. This was a retrospective chart review of patients cared for by the University of South Florida gynecologic oncologists over a 10-year period beginning July 1, 1985. Fifteen patients were identified. Five had a sigmoid stricture. Two of these underwent transverse loop colostomy, and the other three were managed with resection and an anastomosis with protective colostomy. Four patients had severe sigmoiditis, three of which were complicated by hemorrhage. Three of these underwent transverse loop colostomy, and the fourth underwent resection and anastomosis with protective colostomy. Three patients had a sigmoid fistula, with two undergoing transverse loop colostomy and the third undergoing resection and anastomosis with protective colostomy. There were two rectovaginal fistulas, both managed with transverse loop colostomy. One patient had free perforation of the sigmoid colon managed with transverse loop colostomy, and she died 4 weeks later. One patient who had been diverted for severe hemorrhagic proctosigmoiditis developed further bleeding 1 year later from the transverse colon. The transverse colon and colostomy were removed, and the remaining colon was anastomosed. All five patients who had a colorectal anastomosis had their colostomy taken down 2 1/2–8 months postoperatively. One developed a rectovaginal fistula and radiation enteritis 3 months later, necessitating replacement of the colostomy and a small bowel resection. The remaining four patients have done well 7–63 months following colostomy closure. Most cases of severe radiation injury of the rectosigmoid colon require a diverting colostomy. Patients with severe radiation sigmoiditis, sigmoid stricture, and even fistula are sometimes candidates for eventual restoration of intestinal continuity. (J GYNECOL SURG 12:191, 1996)

Complications of an abdominal stoma: an analysis of 322 stomas.

This paper reports a series of 316 patients with 322 stomas, of which 156 were end-sigmoid colostomies (48.5%) and 123 urological ileal conduits (38.2%). An overall complication rate of 66.8% was detected, with parastomal herniation rate, stenotic rate, and prolapse rate of 31.1, 10.2 and 6.8%, respectively. Complications were detected much later in a urological stoma than in a colostomy. Patients bearing an abdominal stoma should be followed up stringently. The creation of an abdominal stoma should not be regarded as a minor surgical procedure. Certain stomas, such as loop transverse colostomy, should be avoided whenever possible.

Factors Influencing the Safety of Colostomy Closure in the Elderly

Although colostomy closure is a commonly performed surgical procedure, there remains concern that the attendant risks may be misjudged, especially in the elderly. The purpose of this study was to evaluate the safety of performing colostomy closure and to define the factors that may influence morbidity and mortality in patients over the age of 70. Three hundred seven patients (178 males, 129 females) underwent colostomy closure over a 5-year period. The mean age was 52 years and 84 (27%) of the patients were 70 years or older. The indications for colostomy included diverticulitis, 115 (38%); malignancy, 47 (15%); perforation 35 (11%); trauma, 34 (11%); congenital anomalies, 26 (8%); obstruction, 13 (4%); bleeding, 6 (2%); colovesical fistulae, 6 (2%); polyps, 2 (0.7%); and miscellaneous, 23 (8%). An end colostomy was performed in 193 (63%) patients and a transverse loop colostomy in the remaining 114 (37%). There were no deaths. Complications occurred in 27 (9%) patients: 17 were directly related to colostomy closure (8 wound infections, 3 intraabdominal abscesses, 3 small bowel obstructions, 2 anastomotic strictures, and 1 anastomotic leak) while 10 were nonsurgical. Risk factors statistically associated with increased morbidity included age >70 years (13% versus 5%), end versus loop colostomy (10% versus 2%), an operative time %gt;2 hr, and estimated blood loss ⩾500 ml (P < 0.05). ASA classification was only predicative of postoperative complications in patients over 70 years of age. We conclude that although colostomy closure can be performed without mortality, the increased morbidity associated with this procedure in patients 70 years or older necessitates careful preoperative assessment.

Colostomy Closure on a Gynecologic Oncology Service

From 7/1/85 to 6/31/92 25 colostomy closures were performed. Twenty-one of the colostomies were performed in relation to gynecologic cancer and the remaining 4 were performed for benign pelvic disease. Nineteen patients underwent simple closure of a transverse loop colostomy. The other 6 patients had their colostomy closed in association with a laparotomy. There were no intraoperative complications related to the colostomy closure. There was 1 postoperative mortality secondary to adult respiratory distress syndrome following reoperation for stricture in the early postoperative period. Three other patients also experienced significant postoperative complications for an overall complication rate of 16%. These included one subcutaneous wound dehiscence, one subcutaneous wound infection, and one anastomotic stricture. One patient required a second colostomy due to recurrence of an obstruction by ovarian cancer in the rectosigmoid area. From the results of this small study, it would appear that colostomy closure is a reasonable endeavor in a selected group of gynecologic cancer patients.

Securing the loop—Historic review of the methods used for creating a loop colostomy

Loop transverse colostomy is a procedure that has been traditionally employed on a temporary basis for a number of indications, but, with improvement of intestinal suturing and stapling techniques, the applicability of this modality has become quite limited. This paper addresses the issue of securing the loop and traces the history of the development of this method to decompress the bowel, to divert the fecal stream, and to defunctionalize the distal colon.

An obituary to the transverse loop colostomy (Gone with the wind)

An obituary to the transverse loop colostomy (Gone with the wind)

Enterostomies--technical aspects.

Loop ileostomy is superior to transverse loop colostomy in defunctioning the colorectum. It is easier to manage and is associated with less problems both in the early and late postoperative period.

Surgical treatment of radiation injuries of the colon and rectum

Between 1950 and 1983, radiation-induced proctitis was diagnosed proctoscopically in 720 patients at the Mayo Clinic. Sixty-two patients with severe colorectal symptoms were treated surgically. The interval from cessation of radiotherapy to onset of symptoms ranged from 3 weeks to 24 months (mean 33 months). The 62 patients underwent a total of 143 operations with 8 operative deaths (13 percent), and 40 patients (65 percent) had 61 complications. The morbidity rate was lower after colostomy alone (44 percent in 27 patients) than after more aggressive operations (80 percent in 35 patients). Transverse loop colostomy and descending colostomy were safer than sigmoid colostomy. The dissection adhesions, opening of tissue planes, and careless manipulation of intestine may result in necrosis and perforation of the intestine, bladder, or vaginal wall; these were the main causes of fecal and other internal fistulas in our study.

A modification of the transverse loop colostomy.

A technique for constructing a permanent transverse loop colostomy that permits distal decompression without risk of distal limb prolapse is described.

Loop ileostomy as an alternative to transverse loop colostomy.

Loop ileostomy as an alternative to transverse loop colostomy.

Technique for totally diverting loop transverse colostomy.

Technique for totally diverting loop transverse colostomy.

Loop transverse colostomy. The case against.

All large-bowel stomas (198) performed between 1970 and 1980 in a community hospital were reviewed. Twenty-nine stomas were loop transverse colostomies. There were five deaths, a complication rate related to the stoma of 28 per cent, and only 18 patients ever achieved colostomy closure. Our conclusions are as follows: (1) transverse colostomy is a holdover from the past; (2) "temporary" loop colostomy is a misnomer; (3) all colostomies should be end-bearing and matured primarily; (4) blind surgery invites tragedy; (5) loop transverse colostomy is a risky first stage with little benefit; (6) every colostomy should be placed as near as possible to the disease process; and (7) resection of the disease is the ideal first stage.

Morbidity and mortality following intraperitoneal closure of transverse loop colostomy

A retrospective analysis of 153 patients having intraperitoneal closure of transverse loop colostomies was performed. The mortality was 1.4 per cent. The morbidity rate was 15 per cent, including 7 per cent wound infection was not significantly improved by the use of systemic or nonabsorbable intestinal antibiotics. Intraperitoneal drainage resulted in the highest rate of wound infection. However, the use of intraperitoneal drains seems justified for the control of fecal fistula if it should occur. The lowest incidence of complication was noted when colostomies were closed in 2--4 months. Particular attention must be given to cases with diverticulitis as these have a greater morbidity. Factors which reduce morbidity appear to be directly related to clean and careful dissection of the bowel with a sound technique of anastomosis.