Sigmoid Colostomy Research Articles

An assessment of colostomy irrigation

One hundred patients with permanent sigmoid colostomies were surveyed to determine their satisfaction and success with the "irrigation" technique of colostomy management. Most patients who irrigate their colostomies achieve continence. Odors and skin irritation are minimized. The irrigation method is economical, time efficient, and allows a reasonably liberal diet. It avoids bulky appliances and is safe. In appropriately selected patients, the irrigation technique is the method of choice for management of an end-sigmoid colostomy.

A simple method for preventing retraction of an end colostomy.

A simple technique for performing a functional end sigmoid colostomy is reported. This procedure can help to prevent retraction of an end stoma in an obese patient or any patient with a shortened mesentery.

The role of colostomy in the management of anorectal malformations

The role of the colostomy in the definitive correction of anorectal malformations is controversial with regard no only to indications for its use, but also to location and type. We reviewed the records of 272 patients with 307 colostomies and analyzed the frequency of complications related to these controversial points. There were 250 completely divided and 57 loop colostomies, constructed in either the sigmoid or transverse colon. Twenty-five colostomies were associated with complications that included retraction, stenosis, dehiscence, prolapse, infection, bowel obstruction, sepsis, and death. Twelve additional colostomies were placed in positions that impeded the definitive correction of the malformation: 9 sigmoidostomies were too distal and 3 were located in the right-upper abdominal quadrant and did not permit pull-through without tension. Colostomy prolapse and pull-through infection were statistically less likely with a completely diverting colostomy. Thirty-five patients with rectovestibular malformations were encountered in this series. Ten were referred from other institutions after attempted repair without a colostomy and all 10 had complications of infection, dehiscence, retraction, and reopening of the fistula. In contrast, there were no complications in the remaining 25, in whom the repair was preceded by a colostomy, nor after re-repair of the other 10. These findings support the need for a colostomy prior to the repair of this malformation. We recommend a carefully constructed, high, completely diverting sigmoid colostomy prior to the initial definitive repair of anorectal malformations. A right transverse colostomy is preferable preceding redo operations.

Congenital Rectovesical Fistula in the Absence of Imperforate Anus

Two neonates with multiple congenital anomalies presented with contamination of the urinary tract with fecal organisms. Both patients had normal anorectal areas but in both, a work-up of the urinary tract infection including cystogram and barium enema revealed a rectovesical fistula. This is highly unusual and as far as can be determined, no reports similar to this could be found. Patient 1 succumbed from severe cardiovascular disease after colostomy so that no further diagnostic or therapeutic measures could be taken. Patient 2 underwent sigmoid colostomy to divert the fecal contamination of the bladder. He then underwent successful surgical division of the rectovesical fistula from an abdominal approach and subsequently had his colostomy closed. Intraoperatively, a catheter placed in the fistula via the rectum was quite helpful in identification of the fistula. This very unique lesion in this second patient was one of a constellation of anomalies including megalourethra, epispadiac urethral fistula, undescended testes, bilaterally, a floppy lower abdominal wall, and absent left kidney. This patient could be construed as a variant of the prune belly syndrome.

Posterior sagittal exposure for reconstructive surgery for cloacal anomalies

We treated seven girls with a cloacal anomaly through a posterior sagittal exposure. Six patients, aged 5 months to 2 1/2 years, underwent a primary reconstructive operation with urethroplasty, vaginoplasty, and posterior sagittal anorectoplasty as a single procedure. All had undergone diverting sigmoid colostomies as newborns, four had previous vesicostomies, and one had a vaginostomy. The seventh girl, a 9-year-old, had undergone a number of attempts at reconstruction. All underwent endoscopy and contrast studies of the cloaca before definitive reconstruction. This preoperative evaluation gave necessary information regarding the length and caliber of the cloacal channel and the level of confluence of the urinary, genital, and intestinal tracts. However, major decisions regarding reconstruction were often possible only in the operating room. To construct a neoanus with optimal sphincteric control, all seven underwent posterior sagittal anorectoplasty. Two required laparotomies to mobilize additional colonic length. Three developed urethrovaginal fistulae after repair. Critical decisions regarding urethral and vaginal reconstruction depend on the findings at cystoscopy and operation. The posterior sagittal approach gives excellent exposure for these decisions and the subsequent reconstruction of three functioning perineal orifices.

Congenital rectovesical fistula in the absence of imperforate anus

Two neonates with multiple congenital anomalies presented with contamination of the urinary tract with fecal organisms. Both patients had normal anorectal areas but in both, a work-up of the urinary tract infection including cystogram and barium enema revealed a rectovesical fistula. This is highly unusual and as far as can be determined, no reports similar to this could be found. Patient 1 succumbed from severe cardiovascular disease after colostomy so that no further diagnostic or therapeutic measures could be taken. Patient 2 underwent sigmoid colostomy to divert the fecal contamination of the bladder. He then underwent successful surgical division of the rectovesical fistula from an abdominal approach and subsequently had his colostomy closed. Intraoperatively, a catheter placed in the fistula via the rectum was quite helpful in identification of the fistula. This very unique lesion in this second patient was one of a constellation of anomalies including megalourethra, epispadiac urethral fistula, undescended testes, bilaterally, a floppy lower abdominal wall, and absent left kidney. This patient could be construed as a variant of the prune belly syndrome.

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.

Hirschsprung's disease in young adults

Hirschsprung's disease is rarely seen in the young adult, and presents unique problems in management because of the massive dilatation and hypertrophy that occur proximal to the aganglionic rectum or the rectosigmoid colon. The diagnosis, which may be suspected by barium enema, is confirmed by suction or full-thickness biopsy of the rectum that may be complemented by anal manometry. Based on our experience with eight patients, a two-stage surgical reconstruction is recommended, with a preliminary sigmoid colostomy through the normally innervated colon and an associated defunctionalized stoma constituting the initial operation. The distal colonic stoma permits cleansing of the caudal colon while the normally innervated proximal colon reverts to near normal caliber, usually within 2 to 6 months. This approach is in accord with the recommendation of Fairgrieve [2]. Reconstruction using a Duhamel or Soave procedure has given good results. The Duhamel procedure seems preferable when a considerable discrepancy remains between the ganglionic and aganglionic segments of rectum [4].

Volatile fatty acids in the human intestine: Studies in surgical patients

Volatile fatty acids (VFA) were measured in digesta taken from the stomata of 39 patients who had undergone large bowel surgery. Total VFA were highest in patients with transverse colostomy and lowest with ileostomy. Levels were intermediate in sigmoid colostomy patients and the same as in faeces from normal controls. The only acid present at the ileostomy site was acetate but in all other samples propionate and butyrate together contributed 30–40% of the total. Neither total nor individual VFA concentrations at any stomal site were related to total fibre intake.

Irrigation management of sigmoid colostomy.

Questionnaires were sent to 270 patients who had undergone abdominoperineal resection and sigmoid colostomy at the Mayo Clinic, Rochester, Minn, during the ten years from 1972 to 1982; 223 patients returned their questionnaires with evaluable data. Sixty percent of the patients were continent with irrigation, and 22% were incontinent with irrigation. Eighteen percent had discontinued irrigation for various reasons. The proportion continent was higher in women, younger patients, and previously constipated patients. A poorly constructed colostomy may cause acute angle, parastoma hernia, stomal prolapse, or stenosis and thus be the cause of failure of irrigation.

String placement and progressive dilatations in the management of high membranous rectal atresia

A newborn with rectal atresia underwent a sigmoid colostomy followed by fluoroscopic placement of a string across the membrane. Progressive dilatations were done until normalization of the rectal canal occurred at 4 months. At 6 months, the colostomy was closed. Although moderate sigmoid dilatation persisted initially, the boy is now developing well and has a normal stooling pattern 3 years following the last procedure. The technique demonstrates the feasibility of high rectal-membrane management without excision.

The Syed-Neblett interstitial template in locally advanced gynecological malignancies

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and afterloading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion r4 cm in diameter) and poor vaginal anatomy were selected for this modality of therapy. In our series the incidence of distant failures of 39 % seems to confirm the significance of local volume of disease as a prognostic indicator; despite a local control rate of 59 % , only 33 % of our patients are alive from 25-51 months. Complications occurred in 12 patients (42 % ). Six patients (22 %) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18 % ) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the 12 patients developing complications are dead of disease. On the basis of this study and be-cause of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidered.

The Syed-Neblett interstitial template in locally advanced gynecological malignancies

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and afterloading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion >4 cm in diameter) and poor vaginal anatomy were selected for this modality of therapy. In our series the incidence of distant failures of 39% seems to confirm the significance of local volume of disease as a prognostic indicator; despite a local control rate of 59 %, only 33 % of our patients are alive from 25–51 months. Complications occurred in 12 patients (42%). Six patients (22 %) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18 %) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the 12 patients developing complications are dead of disease. On the basis of this study and because of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidere

A Large Radiolucent Pelvic Mass in an 81-Year-Old Woman

<h3>History</h3> An 81-year-old woman was admitted to the hospital with a complaint of weakness and constipation. Her temperature was 38.7 °C and her WBC count was 38,300/cu mm. Physical examination suggested the presence of a large pelvic tumor. An abdominal roentgenogram showed a large, spheroid, radiolucent mass, extending from the pelvis into the lower abdomen (Fig 1). <h3>Diagnosis</h3> Squamous cell carcinoma arising in benign ovarian cystic teratoma, with fistulous communication to the sigmoid colon. A barium enema (Fig 2) showed passage of barium into the radiolucent mass. The patient underwent a resection of the pelvic mass and sigmoid colon, colostomy, hysterectomy, and bilateral salpingo-oophorectomy. The tumor was dumbbell-shaped, with a small solid portion containing a few teeth and a large gas-filled portion. The latter was lined by squamous cell carcinoma, which was also present in the fistulous communication to the sigmoid. The patient's postoperative course was complicated by cardiac arrhythmia

Rectal Carcinoma with a Large Amount of Mucin Production in Childhood - Report of a Case

A 10-year-old boy with rectal carcinoma underwent an abdominoperineal resection with postoperative radiotherapy and chemotherapy. The tumor showed a moderately differentiated adenocarcinoma with a large amount of mucin production. Five years later, obstructive hydronephrosis due to postoperative radiotherapy developed and uretero-ileo-cysto-neostomy was performed after transient bilateral nephrostomies. He is now 17 years of age, 7 years after the initial operation, and doing well with nearly normal renal function. Colorectal carcinoma in childhood is very rare and has a poor prognosis, which seems due to the high incidence of mucinous adenocarcinoma and delay in early diagnosis. Besides polyp carcinoma with low grade malignancy, an aggressive abdominoperineal resection with sigmoid colostomy is the treatment of choice as in adults. Postoperative radiotherapy under a total of 3000 rads is also recommended for a better chance of cure. The effectiveness of pre- and postoperative chemotherapy is still doubtful.

Colostomy complications in children. An analysis of 146 cases.

This report analyzes the course of 146 pediatric patients with colostomies in reference to problems with colostomy formation, management, and subsequent closure. Colostomy was performed predominantly for Hirschsprung's disease (70 cases) and imperforate anus (46 cases). A transverse colostomy was done in 120 patients (82%), and a sigmoid colostomy in the remaining patients. Loop colostomies were five times more frequent than divided colostomies. Early major complications occurred in 24 patients (16%). Stomal complications occurred in 69 patients and were more frequent after loop colostomies. Colostomy revision was required in 24 cases. Sigmoid colostomy had a significantly lower complication rate (P less than .01). One hundred nine patients underwent colostomy closure. Major complications occurred in 16 cases (15%). There were no deaths related to colostomy closure. The use of a sigmoid colostomy when possible and close attention to technical details, principles of stomal care, and proper parental instruction should minimize morbidity.

I. Primary Linitis Plastica Type of Carcinoma of the Rectum —Report of a Case and Review of the Literature—

In this paper, a rare case of primary linitis plastica type of colonic cancer is presented with review of the literature.A 35-year-old man was admitted to our department of surgery seeking for the treatment of complete stenosis of the rectum on March 22, 1976. At once, primary loop sigmoid colostomy and biopsy at the white and thick rectal wall were performed. The postoperative roentgenologic examinations reveraled complete narrowing of the rectum about 10 cm in length and the endoscopic examinations showed edematous swollen mucous membrane covered with copius mucus. Neither tumor nor ulcer was recognized. Based upon the histological examinations and clinical findings, the final diagnosis of primary linitis plastica type of carcinoma of the rectum was made. Hence, the combined therapies of oral administration of 5-fluorouracil and cobalt-60 irradiation were begun resulting in marked resolution of the neoplasm and remarkable relief of the clinical symptoms 2 months after the onset of treatment during the period of 20 months. But, in Novomber 1977, numerous dermal metastases came out at the lumbar region the head and the chest wall. The patient was gradually emaciated and died of cachexia on June 2, 1978.In the literature of the world from 1951 through 1976, only 34 cases of primary linitis plastica type of colonic carcinoma have been reported. The clinical aspects of this case was discussed as comparison with the 34 cases.

Diverting loop sigmoid colostomy with noncontaminating rectal irrigation

The Journal of Trauma: Injury, Infection, and Critical Care: April 1978 - Volume 18 - Issue 4 - p 293

Rapid totally diverting loop sigmoid colostomy with noncontaminating rectal irrigation

Loop sigmoid colostomy employing a stapling device and catheter irrigation of the distal segment is less time-consuming and has less potential for contamination than the standard double-barrel colostomy. Unlike the standard loop colostomy, it is totally diverting.

A GIFT OF HOPE

uneaten food. He had only a few of his own teeth, and those were half rotted away. He wore partial dentures that were poorly fitted and clicked loudly when he spoke. Fred looked like he had given up living. In 1974, Fred had been diagnosed as having carcinoma of the rectum, and at that time a sigmoid colostomy was done. The cancer spread, and over the next three years he was treated with chemotherapy. The cancer metastasized to his penile area, cutting off the blood supply to his penis and scrotum. When that area became infected and