Retroperitoneal abscess following sclerotherapy for hemorrhoids

A case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoid is presented. Subsequent necrosis of the underlying tissues produced a rectal perforation and retroperitoneal abscess, which necessitated emergency laparotomy and defunctioning colostomy. Healing of the perforation allowed later closure of the stoma. A brief review of the known complications of this technique has been made. It would appear that necrosis and perforation with abscess formation can be added to this list.     

Simple excision and closure of a distal limb of loop colostomy prolapse by stapler device

Stomal prolapse is one of the common complications in transverse colostomy and can be managed conservatively in most cases; however, laparotomy and reconstruction of the stoma may sometimes be required, especially in case of irreducible colostomy prolapse. We have reported a simple local repair with reconstruction of the loop colostomy. We herein report a new more simple technique to avoid laparotomy and allow excision of the irreducible colostomy prolapse and complete closure of the distal limb of loop colostomy when no decompression is required in the distal limb of the stoma. In this procedure, the number of stapler and the time with blood loss for the operation can be saved.     

Gastrointestinal perforations in neonates with anorectal malformations.

We describe the presentation and management of gastrointestinal perforation in four neonates with anorectal malformations. Two neonates with high malformation had pneumoperitoneum on X-ray; surgery revealed sigmoid perforation in one patient and transverse colon perforation in the other. Colostomy was done, followed by posterior sagittal anorectoplasty at four months; both recovered satisfactorily. The third neonate had no radiological feature of gut perforation but cecal perforation was found at surgery; the neonate recovered following right hemicolectomy with stoma followed by anorectoplasty at five months. The fourth neonate presented with clinical and radiological features of perforation and recovered satisfactorily after anoplasty and colostomy.     

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). It is suggested that increased intra-abdominal pressure consequent upon straining in conjunction with frequent bending (rukoo) and kneeling (sujood) during prayer may be associated with an increased risk of stoma prolapse and may be responsible for the differences in stoma prolapse rates identified between Saudi Arabia and New Zealand. Patients should thus be advised not bend or kneel for prayer immediately following colostomy surgery.     

Complicated diverticulosis

"Uncomplicated" diverticulitis can be prevented from progressing into "complicated" diverticulitis by early diagnosis and active medical treatment. Complicated diverticulitis develops from a peridiverticular abscess, to a perforation with peritonitis, to fistulation into adjacent viscera, to luminal narrowing by inflammation or stricture formation causing obstruction. Computer tomography (CT) scanning is the diagnostic imaging modality when diverticulitis is suspected and allows percutaneous drainage of peridiverticular abscesses that will enhance the effect of antibiotic therapy with resolution of the acute episode in 75% of patients. Thus, an emergent or urgent operation is converted to an elective operation and a two-stage operative procedure, namely a temporary stoma and a second operation, is avoided.Interventional surgery is urgent for perforation and obstruction. While a Hartmann's resection and temporary colostomy has been the favoured operative procedure, under favourable conditions resection with primary anastomosis is preferable. Although a temporary stoma may be required with primary anastomosis, and hence the procedure is a two-stage one similar to a Hartmann's, the closure of the stoma is less demanding and has a lower morbidity. A single-stage resection and anastomosis is the standard elective treatment for symptomatic fistulas and strictures.     

Correction of end colostomy prolapse using a curved surgical stapler, performed under sedation

Acute stoma prolapse most commonly occurs following emergency surgery, frequently in patients with significant medical co-morbidities. Correction often requires re-laparotomy and resiting of the stoma, placing an already frail patient at risk of further morbidity. An elderly patient experienced an end colostomy prolapse 14 days following emergency laparotomy. A novel technique was employed using the CONTOUR^® curved stapling device to excise the prolapsed segment, under a brief period of intravenous sedation, thereby avoiding the sequelae of general anaesthetic. No complications were experienced, and the patient was deemed fit for discharge 5-days post re-intervention.     

Local correction of a transverse loop colostomy prolapse by means of a stapler device

Abstract. Prolapse is a common complication in patients with a transverse loop colostomy. In most cases, the prolapse can be managed conservatively awaiting time for closure eventually. However, loop stoma may also be intentionally permanent or the patient may be too fragile to have the colostomy closed and in these cases a laparotomy is required for correction of the prolpase. A simple method allowing local correction of the prolapsed loop stoma is described.     

Stoma siting using CT guidance in a multiply scarred abdomen

The creation of a stoma in a multiply scarred abdomen is often difficult because of intra-abdominal adhesions and limited suitable skin sites. We report a simple technique utilising computed tomography which allowed the easy creation of a defunctioning loop colostomy in such an abdomen by simple trephine rather than laparotomy.     

Complications of colostomy closure

A series of 126 colostomy closures was analyzed to evaluate factors contributing to morbidity. There were no deaths, but there was a 33 percent complication rate. Patients with penetrating abdominal trauma and foreign-body rectal perforations had fewer serious complications following colostomy closures than patients with diverticulitis or cancer. No significant difference was found in the anastomotic leak rate, length of surgery or length of hospitalization in patients with sutured or stapled anastomoses. Most patients in this series had end colostomies that required limited resection and anastomoses. Complication rates were comparable with previous series, which consisted predominantly of loop colostomy closures. The incidence of surgical complications was not related to the time interval between colostomy formation and closure. Timing of closure, however, significantly influenced the complication rate in two specific patient groups: patients with intraperitoneal colon perforation at the initial procedure when closure was performed within four weeks, and patients with surgical complications at the time of colostomy creation if they underwent closure within eight weeks. Early closures in patients still recovering from colostomy complications were associated with the highest incidence of anastomotic leak. Wound infections at stoma sites were decreased by leaving the skin open. The average hospitalization was 11.1 days for patients without complications, 15.5 days for those with wound infection, 18.5 days for patients with ileus, and 20.4 days for patients with anastomotic leaks. This study illustrates that the optimal time for colostomy closure must be determined on an individual basis. The morbidity can be minimized by delaying closure in specific groups of patients for one to two months. Delaying closure for an arbitrary time interval in all patients, however, is not warranted.     

Temporary colostomy for trauma

A technique for construction of a functional loop colostomy is described for the management of colonic injuries in which complete fecal diversion is not required. The colostomy and mucous fistula are converted into a functional loop colostomy at the initial procedure and exteriorized through a single stoma. Subsequent colostomy closure is simplified. Intraperitoneal colostomy closure can usually be performed by mobilizing the colon at the stoma site without resorting to formal laparotomy     

Umbilical colostomy: A better intestinal stoma

Conclusions This study was undertaken to evaluate our experience with umbilical colostomy. There were 101 cases available for review. Four patients had major complications that necessitated reoperation, an incidence of 3.9 per cent. One patient was operated on for necrosis of the stoma, one for retraction, and two for periostomal evisceration of omentum and small bowel. Three patients had minor strictures requiring digital dilatation, and one needed minor revision under local anesthesia. No patient had a peristomal hernia or prolapse, making this a distinctly better colostomy than the conventional left-lower-quadrant colostomy. The ease and comfort in the care of this colostomy were evident during follow-up visits. We feel that this procedure has all the advantages of a conventional matured colostomy and has extra advantages of easy accessibility and absence of peristomal hernias and prolapse. For any elderly patient who needs a permanent colostomy, umbilical location of the stoma offers distinct advantages. Read at the meeting of the American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, May 2 to 6, 1976.     

Complications of colostomy closure

A series of 126 colostomy closures was analyzed to evaluate factors contributing to morbidity. There were no deaths, but there was a 33 percent complication rate. Patients with penetrating abdominal trauma and foreign-body rectal perforations had fewer serious complications following colostomy closures than patients with diverticulitis or cancer. No significant difference was found in the anastomotic leak rate, length of surgery or length of hospitalization in patients with sutured or stapled anastomoses. Most patients in this series had end colostomies that required limited resection and anastomoses. Complication rates were comparable with previous series, which consisted predominantly of loop colostomy closures. The incidence of surgical complications was not related to the time interval between colostomy formation and closure. Timing of closure, however, significantly influenced the complication rate in two specific patient groups: patients with intraperitoneal colon perforation at the initial procedure when closure was performed within four weeks, and patients with surgical complications at the time of colostomy creation if they underwent closure within eight weeks. Early closures in patients still recovering from colostomy complications were associated with the highest incidence of anastomotic leak. Wound infections at stoma sites were decreased by leaving the skin open. The average hospitalization was 11.1 days for patients without complications, 15.5 days for those with wound infection, 18.5 days for patients with ileus, and 20.4 days for patients with anastomotic leaks. This study illustrates that the optimal time for colostomy closure must be determined on an individual basis. The morbidity can be minimized by delaying closure in specific groups of patients for one to two months. Delaying closure for an arbitrary time interval in all patients, however, is not warranted. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.     

Korrektur des Kolostomie-Prolapses mittels Stapler

Prolapse of an end colostomy is an event that considerably impairs the affected patient, including not only poor ability to provide care, but also bleeding via mechanical irritation and significant peristomal skin problems. End colostomy is generally performed in order to allow defecation after rectum amputation. Theprolapse of the stoma is often associated with a parastomal hernia, the correction of which is urgent. An isolated prolapse of the stoma occurs less frequently and generally results from nonoptimal construction (insufficient resection). In most older patients, the correction is associated with increased risks. A new technique, which allows the stoma prolapse to be quickly and safely corrected, is presented. The advantages include the significant shortening of the operation time, and the possibility to perform the operation under analgosedation.     

腹腔镜腹会阴联合切除术腹膜外结肠造口对比腹膜内造口治疗直肠癌的Meta分析

目的比较直肠癌行腹腔镜腹会阴联合切除术（LAPR）腹膜外结肠造口与腹膜内结肠造口的安全性与有效性,并确定直肠癌永久性结肠造口最为合适的造口方式。 方法检索Pubmed、Embase、The Cochrane Library、Web of Science、中国知网以及万方数据库等中英文数据库,收集2008年10月至2020年3月国内外公开发表的有关比较LAPR腹膜外造口与腹膜内造口治疗直肠癌的临床研究,由两位研究者按照纳入与排除标准筛选符合条件的文献,非随机对照研究采用Newcastle-Ottawa Scale（NOS）量表评价文献质量,评分>5分的研究纳入Meta分析,随机对照研究采用Jadad量表评估。提取文献基本信息及相关结局指标,数据采用RevMan5.3软件进行Meta分析。 结果最终纳入14篇文献,其中9篇临床对照研究,5篇随机对照研究,共计1 210例患者。其中腹膜外造口组594例,腹膜内造口组616例,Meta分析结果显示,与腹腔镜腹膜内造口相比,腹腔镜腹膜外造口组造口旁疝发生率（OR=0.14,95%CI：0.08~0.25;P<0.00001）,造口脱垂发生率（OR=0.15,95%CI：0.06~0.37;P<0.0001）,造口回缩发生率（OR=0.24,95%CI：0.09~0.63;P=0.004）均明显降低;术后住院时间缩短（MD=-0.82,95%CI：-0.97~-0.68;P<0.00001）,术后首次排气时间提前（MD=-0.71,95%CI：-0.88~-0.54;P<0.00001）,更容易获得排便感（OR=9.67,95%CI：4.40~21.23;P<0.00001）,但造口水肿发生率明显升高（OR=1.81,95%CI：1.13~2.92;P=0.01）,而两组造口狭窄发生率（OR=0.62,95%CI：0.25~1.50;P=0.29）、造口感染发生率（OR=0.57,95%CI：0.29~1.12;P=0.10）以及造口时间（MD=-0.94,95%CI：-5.69~3.81;P=0.70）的差异均无统计学意义。 结论LAPR腹膜外造口能明显降低造口相关并发症的发生率,加速患者康复,更容易获得排便感,具有一定的安全性和有效性,建议直肠癌LAPR永久性结肠造口首选腹膜外造口方式。     

A method and the results of loop colostomy

A technique of loop colostomy which avoids a sutured skin wound, employs a deep tension suture with retained polythene sleeve as a bridge, and permits routine use of standard terminal colostomy appliances is described. The clinical results in 51 patients are reported and the advantages of this method of construction discussed. All patients were able to use standard, terminal colostomy appliances routinely from the time of construction. There were no immediate postoperative complications. Delayed complications occurred in 5 (10 per cent) patients. Intraperitoneal closure was performed in 43 patients and was complicated by 1 (2.3 per cent) transient fecal leak and 4 (9.3 per cent) would infections. The absence of a sutured skin wound, the small bridge size, and the circular shape of the stoma facilitate use of accurately fitting, standard terminal colostomy appliances rather than the usual loop colostomy apparatus. This results in an improved skin seal, reduced fecal leakage, easier nursing and stoma care, and better patient morale.     

Complications of median versus lateral colostomy

Summary The purpose of this study is the evaluation of early and late complications in two groups of patients: 143 patients with lateral colostomy and 68 patients with median colostomy. Patients were followed for periods ranging from three months to three years. Early complications included skin irritation, bleeding, ischemia, infection, and retraction. Late complications included hernia, prolapse, and stenosis. From the analysis of the case series, the authors conclude that (1) double-barreled colostomies have a higher complication rate than do simple colostomies; (2) after double-barreled colostomy, late and early complications occur more frequently if the site of the stoma is midline; (3) with regard to terminal colostomies, the incidence of complication varies-bleeding, stenosis and retraction appear to be more frequent in median stoma, while prolapse occurs more frequently in lateral stoma. No difference, was found in the percentage of surgical revisions. The authors prefer to place the stoma in the left lower quadrant, of the abdomen, since, after median laparotomy, a lateral colostomy has less risk of stenosis.     

Colon perforation: a rare complication during percutaneous nephrolithotomy

Only a few cases of colon perforation during percutaneous nephrolithotomy (PCNL) have been reported. We present here a case of colon perforation during PCNL that was managed conservatively by stenting the urinary tract, using the percutaneous catheter as the colostomy tube, and giving broad-spectrum antibiotics. This report also reviews the anatomic and technical access to the kidney and reminds the urologist about this rare but serious complication of PCNL.     

Elective Stoma Construction Improves Outcomes in Medically Intractable Pressure Ulcers

PURPOSE: Perineal pressure ulcers are a common and devastating complication for paralyzed or chronically bedridden patients. Controversy exists on the benefit of fecal diversion for the treatment and prevention of these ulcers. This study compared outcomes in bed-bound patients with pressure ulcers who electively underwent fecal diversion with those who did not. METHODS: A retrospective review was performed on all disabled patients who underwent surgery for medically intractable pressure ulcer from 1993 to 2001. Charts were divided into the colostomy group or noncolostomy group. Recurrence rates, healing times, morbidity and mortality, and number of reoperations were calculated for each group. Additionally, stoma patients were interviewed for quality of life assessment. RESULTS: Sixty-seven patients were treated during the study period (colostomy, n = 41; noncolostomy, n = 26). The majority of colostomies were performed laparoscopically, with a 9.7 percent incidence of postoperative complications. The ulcer recurrence rate was lower in the treated colostomy group (43 percent) compared with the noncolostomy group (69 percent; P < 0.05). In addition, noncolostomy patients had longer healing times (7 vs. 3 months; P < 0.05), and this group required more ulcer operations than the stoma patients did. Quality of life and bowel care were much improved by the colostomy. CONCLUSIONS: Stoma construction is a safe procedure with low morbidity and mortality that helps heal pressure ulcers and decreases the incidence of recurrence. Additionally, laparoscopic stoma construction represents a technical advance that may reduce operative complications that have been previously reported with open fecal diversion.     

Adenocarcinoma of a colostomy following abdominoperineal resection for squamous cell carcinoma of the anal canal: a case study

Malignant neoplasms presenting on a stoma, as well as the development of colorectal adenocarcinoma after previous treatment for squamous cell carcinoma (SCC) of the anal canal, are rare. The unique case is presented of an 81-year-old woman with parastomal bleeding and ulceration found to have a primary colorectal adenocarcinoma arising de novo on a colostomy, formed after salvage abdominoperineal resection (APR) 3 years earlier for recurrent anal SCC. This is the first reported case of a colonic adenocarcinoma on a colostomy formed after an APR for anal SCC. Although stomal neoplasia is rare, the appearance of a friable bleeding lesion on the stoma should be investigated to exclude metastatic cancer or a second primary malignancy.