Anorectal-vestibular fistula without an imperforate anus in female infants: report of three cases.
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An anorectal-vestibular fistula without an imperforate anus in female infants is a rare clinical condition. This report is based on a series of 3 female infants who had fistulous communication between the bowel and the vestibule coexisting with a normal anus. Redness of the external genitalia over the labia major was the initial symptom in all 3 cases, and a suppurative discharge of pus mixed with stools was also found at the orifice of the fistula. Based on our experience, initial surgery with a double-barrel colostomy followed by a sequential fistulectomy might be safe and curative. We also review the related literature for the pathogenesis. (+info)
Role of biological mesh in surgical treatment of paracolostomy hernias.
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BACKGROUND: Paracolostomy hernia is a frequent complication of intestinal stoma. Its correction can be made through relocation of the colostomy or by keeping it in place and performing abdominal wall reinforcement through direct suturing with or without a prosthesis. METHOD: Results of surgical treatment of paracolostomy hernias were analyzed in 22 patients who underwent surgery in our hospital during the past 15 years, with or without biological mesh (bovine pericardium). All patients had terminal colostomies after abdominoperineal excision of the rectum. RESULTS: In 15 (68.2%) patients, hernia correction was made by maintaining the colostomy in place, in 2 of them (9.1%) without reinforcement, and in the other 13 (59.1%) through reinforcement of the aponeurosis with biological mesh. In the 7 (31.8%) other patients, hernia correction was accomplished by relocation of the colostomy. The mean follow-up period was 50.2 months. Recurrence was observed in 3 (13.6%) patients after a median of 16 months post-correction. CONCLUSION: Paracolostomy hernia remains a surgical challenge due to its high recurrence rate. Primary repair using a prosthesis of biological material may be preferable since muscle-aponeurotic weakness is frequently observed. (+info)
Development and validation of a quality of life questionnaire for patients with colostomy or ileostomy.
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BACKGROUND: Quality of life of stoma patients is increasingly being addressed in clinical trials. However, the instruments used in the majority of these studies have not been validated specifically for stoma patients. The aim of this paper is to describe the development and validation of a quality-of-life instrument, "Stoma-QOL", specifically for patients with colostomy or ileostomy. METHODS: Potential items were formulated in English on the basis of the results of a series of semi-structured interviews with 169 adult stoma patients. The process resulted in a preliminary 37-item version, which was translated into French, German, Spanish and Danish, and administered repeatedly to 182 patients with colostomy or ileostomy. A psychometric selection of items was performed through Rasch Analysis. The measurement properties of the final questionnaire version were subsequently tested. RESULTS: The 20 items in the final questionnaire covered four domains--sleep, sexual activity, relations to family and close friends, and social relations to other than family and close friends. These items were found to define a unidimensional variable according to Rasch specifications (Infit MNSQ < 1.3). Internal consistency reliability calculated as Cronbach's alpha was 0.92, i.e., highly reliable. Spearman's correlation coefficients of scores across times of administration was > 0.88 (p < 0.01), indicating a high test-retest reliability. Item calibrations by country calculated as ICC were 0.81 (0.67-0.91 95% CI), confirming cross-cultural comparability across the European countries included in the study. CONCLUSION: Given the adequacy of the metric properties of the Stoma-QOL suggested by the psychometric analyses, this study confirms the suitability of the instrument in clinical practice and in clinical research. (+info)
Complications and mortality following stoma formation.
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INTRODUCTION: As stoma formation is thought to be declining, we performed a study to evaluate the rate of stoma formation and the impact on stoma complication rates, together with risk factors for complications. PATIENTS AND METHODS: Stoma incidence, individual complications and mortality rates were retrieved from a stoma nurse database of 345 stomas created over an 8-year period. RESULTS: Stoma formation increased over the study period, although the incidence of complications declined. Stoma complications were more frequently seen in emergency surgery. A significant association between stoma complications and mortality was identified. CONCLUSIONS: Age of patient, urgency of surgery and diagnosis were associated with high levels of morbidity and mortality. Stomas are often formed in frail patients unsuitable for anastomosis formation, which may explain the high mortality in ostomy patients. (+info)
Metachronous stomal adenocarcinoma following abdominoperineal resection for rectal cancer.
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Although metachronous colorectal tumours are relatively common, they seldom occur at stomasites. We present the case of a 57-year-old woman who developed a colostomy site malignancy. Possible associations and risk factors are discussed. (+info)
Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study.
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INTRODUCTION: The introduction of orthogonal polarization spectral (OPS) imaging in clinical research has elucidated new perspectives on the role of microcirculatory flow abnormalities in the pathogenesis of sepsis. Essential to the process of understanding and reproducing these abnormalities is the method of quantification of flow scores. METHODS: In a consensus meeting with collaboraters from six research centres in different fields of experience with microcirculatory OPS imaging, premeditated qualifications for a simple, translucent and reproducible way of flow scoring were defined. Consecutively, a single-centre prospective observational validation study was performed in a group of 12 patients with an abdominal sepsis and a new stoma. Flow images of the microcirculation in vascular beds of the sublingual and stoma region were obtained, processed and analysed in a standardised way. We validated intra-observer and inter-observer reproducibility with kappa cross-tables for both types of microvascular beds. RESULTS: Agreement and kappa coefficients were >85% and >0.75, respectively, for interrater and intrarater variability in quantification of flow abnormalities during sepsis, in different subsets of microvascular architecture. CONCLUSION: Semi-quantitative analysis of microcirculatory flow, as described, provides a reproducible and transparent tool in clinical research to monitor and evaluate the microcirculation during sepsis. (+info)
Alleviating debilitating, chronic constipation with colostomy after appendicostomy: a case study.
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Severe chronic constipation is a debilitating condition. Patients not only experience infrequent bowel movements, but also are often frustrated by the sensation of incomplete evacuation; pain; straining; daily use of enemas; and continual concerns regarding diet, fluids, and medications. Diagnostic tests are performed to rule out organic causes of the condition. Common treatment options consist of dietary fiber supplementation, dietary instruction, adequate fluid intake, enemas, and laxatives; additional noninvasive management includes biofeedback training and botulinum toxin type A injections. Surgery is rarely recommended, although a select group of patients may benefit from antegrade continence enema procedure. A female patient presented with a history of long-standing constipation. When antegrade continence enema offered no improvement and other treatment measures failed, she underwent successful laparoscopic-assisted sigmoid resection and end colostomy. This approach may provide options for patients in similar circumstances. (+info)
Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructed sigmoid colon cancer: a case report.
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Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently. (+info)