Combined Side-to-End Anastomosis with Temporary End Colostomy for the Management of Selected Left-Sided Colonic Emergencies

2011 ◽  
Vol 77 (4) ◽  
pp. 447-450
Author(s):  
Michael Safioleas ◽  
Michael Stamatakos ◽  
Panayoitis Safioleas ◽  
Konstantinos Safioleas ◽  
George H. Sakorafas
Keyword(s):  
Left Colon ◽  
Colostomy Closure ◽  
Colonic Segment ◽  
Initial Surgery ◽  
Surgical Emergencies ◽  
Stump Closure ◽  
End Colostomy ◽  
Mechanical Stapler ◽  
Surgery Mortality ◽  
New Surgical Technique

Management of surgical emergencies of the left colon commonly requires excision of the colonic segment bearing the lesion, creation of an end colostomy, and closure of the rectosigmoid stump. Closure of the end stoma may be technically challenging. During this study, we used a new surgical technique involving the creation of an end-to-side anastomosis of the rectosigmoid stump to the base of the proximal colonic segment in association with an end colostomy. During a 15-year period, 23 patients were offered this type of surgery. Mortality was zero. Complications were observed in seven patients (morbidity, 7/23). Mean hospitalization time was 12.3 days. Closure of the colostomy was performed approximately 1 month after initial surgery and was easily performed using a mechanical stapler, either intraperitoneally or even extraperitoneally. No complications were observed after closure of the colostomy. The described technique is a useful alternative for the management of selected patients with left-sided colonic surgical emergencies. Its main advantage is that it greatly facilitates colostomy closure, which is performed earlier compared with the colostomy closure after a typical Hartmann's procedure.

scholarly journals Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

2015 ◽  
Vol 100 (6) ◽  
pp. 984-988 ◽  
Author(s):  
Giulia Montori ◽  
Giacomo Di Giovanni ◽  
Zeineb Mzoughi ◽  
Cedric Angot ◽  
Sophie Al Samman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Laboratory ◽  
Left Thigh ◽  
Left Colon ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Computed Tomography Scan ◽  
End Colostomy ◽  
Retroperitoneal Perforation ◽  
Tomography Scan

Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.

scholarly journals Comparison between endoloop and linear mechanical stapler for the appendicular stump closure

2019 ◽  
Vol 86 (5) ◽  
Author(s):  
Juan J. Granados-Romero ◽  
Alan I. Valderrama-Treveriño ◽  
Baltazar Barrera-Mera ◽  
Karen Uriarte-Ruíz ◽  
Rodrigo Banegas-Ruiz ◽  
...  
Keyword(s):  
Stump Closure ◽  
Mechanical Stapler ◽  
Appendicular Stump ◽  
Appendicular Stump Closure

Laparoscopic versus Open End Colostomy Closure: A Single-center Experience

2014 ◽  
Vol 80 (4) ◽  
pp. 361-365 ◽  
Author(s):  
Peter Studer ◽  
Beat SchnüRiger ◽  
Melika Umer ◽  
Dino KröLl ◽  
Daniel Inderbitzin ◽  
...  
Keyword(s):  
Conversion Rate ◽  
Hospital Length ◽  
Colostomy Closure ◽  
Hospital Length Of Stay ◽  
Perforated Diverticulitis ◽  
Continuous Variables ◽  
Single Center Experience ◽  
End Colostomy ◽  
Laparoscopic Closure

The aim of this study was to review our experience with laparoscopic end colostomy closure. A retrospective review of a prospectively entered database was performed. Proportions and continuous variables were compared using the Fisher's exact and the Mann-Whitney U tests, respectively. Within the study period, 53 patients underwent closure of end colostomies. The main reasons for the colonic resections were perforated diverticulitis (52.7%) and neoplasms (20.8%). In 28 patients (53%), laparoscopic closure (LC) was attempted. Demographics did not differ between the attempted LC and the primary open closure (OC) group. The conversion rate from an LC to an OC was 50 per cent (14 of 28), mostly as a result of adhesions (71.4%). Hospital length of stay (HLOS) was significantly longer for the OC than with the attempted LC group (15.4 ± 11.9 days vs 11.3 ± 8.5 days, P = 0.046). The overall complication rate was not different between the completed LC and the OC groups (43 vs 56%, P = 0.634). The majority of complications detected (91.1%) were minor and could be treated conservatively. The role of laparoscopy to close end colostomies is questionable, because the conversion rate is high. However, a shorter HLOS can be expected when laparoscopy is successful. To reduce morbidity resulting from prolonged operation times, it is crucial to convert early and pre-emptively if hostile adhesions are found.

Healing of a left colon anastomosis after early colostomy closure

1988 ◽  
Vol 3 (1) ◽  
pp. 59-64 ◽  
Author(s):  
P. Udén ◽  
P. Blomquist ◽  
H. Jiborn ◽  
B. Zederfeldt
Keyword(s):  
Left Colon ◽  
Colostomy Closure ◽  
Colon Anastomosis

scholarly journals Microsatellite Instability Incidence in Recurrent Colon Cancer Stage II and III

2020 ◽  
pp. 1-5
Author(s):  
Guzmán-Casta Jordi
Keyword(s):  
Colon Cancer ◽  
Microsatellite Instability ◽  
Clinical Stage ◽  
Mucinous Carcinoma ◽  
Signet Ring Cell ◽  
Left Colon ◽  
Stage Ii ◽  
Lower Rectum ◽  
Cross Sectional ◽  
Initial Surgery

Objective: To evaluate the incidence of Microsatellite Instability (MSI) in patients with Colon Cancer in stage II & III in the Mexican population. Methods: This is a descriptive, retrospective and cross-sectional study performed through a review of 30 clinical charts of patients with the diagnosis of Colorectal Cancer and evaluation of Microsatellite Instability in surgical pathology specimens. Results: Males with 53.3% had a higher incidence than females. The most frequent site was the left colon (53%), followed by the right colon (16.6%), higher rectum (10%), mid rectum (10%), and lower rectum (10%). The majority of the patient were classified as moderately differentiated (86.7%), with 6.7% being poorly differentiated and the rest 6.7% well differentiated. For the presence of MSI in repair genes (MLH1, MSH2, PMS2), this was positive in 33% of the population studied. The clinical-stage most frequently affected was IIA with 36.7% of the positive cases followed by stage IIB with 20%, stage IIIA 20%, and finally, stage IIC and IIIB with 13% and 10% respectively. Among histologic subtypes, adenocarcinoma was found in 90% of the cases, mucinous carcinoma in 6.7%, and signet ring cell carcinoma in 3.3%. In regards to treatment, 50 % of patients underwent only surgery while the other 50% were treated with surgery followed by adjuvant chemotherapy. Clean surgical margins were achieved in 93.7% after initial surgery and the rest were taken back to surgery for a wider resection. The predominant tumor size was T2 (50%), T3 (33%), and T4a (16.7%). The most commonly found lymph node involvement was N1a with 63.3% of the cases followed by N1b with 16.7%. In terms of recurrent metastatic disease, M1a was the most frequent, found in 73.3% of the cases. Conclusion: In our study population in contrast with current literature from the rest of the world we found a higher presence of microsatellite instability (33% vs 15%) and a higher incidence in the left colon with a definitive impact in the survival of patients.

scholarly journals A study of complications related with colostomy closure

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Anwarul Haq ◽  
Hasnat Ahmad Butt ◽  
Ashfaq Ahmad
Keyword(s):  
Short Note ◽  
The State ◽  
Penetrating Injury ◽  
Colostomy Closure ◽  
Prospective Clinical Study ◽  
Time Interval ◽  
Paediatric Surgery ◽  
Surgical Ward ◽  
End Colostomy ◽  
Made In

Objective: To determine the complications associated with colostomy closure following a suggested protocol and then compare the incidence with recent reported literature and to suggest measures for reduction of morbidity and mortality associated with colostomy closure. Study design: This study is based on a review of all the patients undergoing colostomy closure from August 1995 to September 1997 in East Surgical Ward, Mayo Hospital, Lahore. Material and methods: This prospective clinical study was carried out in the East Surgical Ward, Mayo Hospital, Lahore. A total of 32 patients belong to either sex who underwent colostomy closure following emergency colostomy were included in this study. Patients under 12 years of age were not included as these were managed in Paediatric Surgery Department of Mayo Hospital, Lahore. Time interval between construction and closure of colostomy was three months and all the patients were fit for anaesthesia. Pre-operative barium enema was done prior to admission to check a ny distal pathology like stricture or leakage. In only two cases strictures were found, and these patients were excluded from study. All patients were admitted through the outpatient department three days before operation, and a special proforma was filled for each patient. A detailed history was taken to find the time and indication for colostomy. A short note was made about the state of other injuries and site of colostomy. A thorough examination was performed to find the state of colostomy, type of colostomy and fitness of the patient. Results: A total of 32 patients were included in this study. Of these 26(81.2%) were male and 6 (18.7%) patients were female. 21(65.6%) were with loop colostomy, 7(21.8%) end colostomy with mucus fistula and 4(12.5%) were with end colostomy with Hartmann`s pouch. Penetrating injury of the colons is the most common etiology for colostomy at the initial operation. 15(46.8%) were made in the transverse colon, 13(40.6%) were made in the left colon and 4(12.5%) were made in the right colon. Conclusion: It has been concluded in this study that the most common indication for colostomy construction in Pakistan is the penetrating injury of abdomen. Young males are more commonly suffered from firearm injuries of abdomen. Loopogram should be done before colostomy closure especially in non-traumatic cases.

Erratum: Recurrent Laryngeal Nerve Dissection

1980 ◽  
Vol 45 (3) ◽  
Author(s):  
Frank B. Wilson ◽  
D. J. Oldring ◽  
Kathleen Mueller
Keyword(s):  
Case Report ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Long Period ◽  
Initial Surgery

On page 112 of the report by Wilson, Oldring, and Mueller ("Recurrent Laryngeal Nerve Dissection: A Case Report Involving Return of Spastic Dysphonia after Initial Surgery," pp. 112-118), the paraphrase from Cooper (1971), "if the patients are carefully selected and are willing to remain in therapy for a long period of time," was inadvertantly put in quotation marks.

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