Stapler-assisted stoma prolapse repair with real-time fluorescent angiography using indocyanine green

Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Transverse loop colostomy is most commonly involved. Although ostomy function is rarely impaired, large prolapses may cause patients distress and impair stoma dressing. Strangulation and ischemia of the prolapsed segment have been reported as complications. Herein, we report a stapler-associated repair of a prolapsed transverse loop colostomy with real-time perfusion studies using indocyanine green.

Indications and complications of colostomy in newborn: our experience

Background: The aim of the present study was to evaluate the indications, complications and outcome of colostomy in newborn patients.Methods: This is a descriptive, retrospective study carried out in the Department of Pediatric surgery, Gandhi Medical College Bhopal to evaluate acceptance and outcome of colostomy in newborn over a one year period from March 2018 to March 2019. All newborn with diagnosis of anorectal malformation, Hirshsprungs disease and other emergency conditions underwent transverse loop colostomy by expert and trained pediatric surgeon.Results: Out of 40 patients operated complications of colostomy was seen in 18 (45%) patients. Most common complication was skin excoriation in 08 patients (20%), bleeding from stoma site in 02 (05%) cases. Stoma prolapse occurred in 02 (05%) patients. Wound infection, dehiscence, stomal stenosis and parastomal hernia was seen in one patient each 2 (2.5%). 2 (0.5%) patient died due to multiple congenital anomalies.Conclusions: Colostomy in children is associated with significant morbidity in developing country. To minimize these problems, the pediatric surgeon should focus on the management and early closure of a colostomy.

A clinical study of colostomies in infancy and childhood in a tertiary centre

Background: The word stoma is derived from the Greek word stoma meaning mouth or opening. Intestinal stoma are surgically created opening that connect part of gastro-intestinal tract with the anterior abdominal wall. The use of various types of colostomies can be lifesaving. Since at our centre we regularly perform colostomies in treatment of various conditions in paediatric age group, this clinical study was undertaken.Methods: This clinical study was conducted in the Department of General Surgery at College of Medicine and JNM Hospital, Nadia. The study was conducted during the period from August 2018 to July 2019. The patients aged day 1 to 12 years were admitted.Results: In the one year study period, 33 cases of paediatric colostomies were performed. 17 (51.5%) were male and 16 (48.5%) were females. Majority of the patients at the time of colostomy were in the early neonatal period. A total of 22 (66.6%) cases underwent colostomy at our hospital and 11 (33.4%) patients had undergone colostomy elsewhere. Majority of the cases who had undergone colostomy were of sigmoid loop variety and 9 patients (27.3%) had transverse loop colostomy. A total of 12 patients (36.36%) suffered post colostomy major complications needing attention.Conclusions: The child is a socio-psycho-biological unit and colostomy leads to substantial psychological trauma for the child and parents. Careful examination is the key to diagnosis and initial management. An appropriately indicated, properly constructed temporary stoma is frequently unavoidable and lifesaving.

Case Report: Newborn with Anorectal Malformation

Anorectal malformations are defined by the relationship of the rectum to the sphincter complex and can be classified as high and low anomaly based on whether meconium is present or absent, presence of dimple, anocutaneous reflex, sacral abnormality or presence of meconium in urine. The diagnosis should be made in the delivery room by inspecting the perineum. Meconuria with absence of anal opening invariably indicates a high malformation which requires a colostomy in the newborn period. Low malformations do not become evident until 24 hours when the meconium may show up in the perineal fistula. These defects can be managed by a perineal anoplasty without a colostomy in the newborn period. A prone cross table lateral shoot abdominal film is required if clinical information at 24 hours is insufficient to decide whether a colostomy is needed. We present a case of newborn, day 4 of life, who did not pass meconium since birth, had abdominal distension, vomiting, poor feeding and lethargy since last 2 days. Anal area showed pigmentation with presence of median raphe, anal dimple and slightly formed anal opening. Baby was initially thought as a case of low type imperforate anus. On further evaluation, was found to have meconuria too. Invertogram done showed high type defect. Rest of the examination was normal. Supportive therapy was initiated and baby underwent transverse loop colostomy for high type imperforate anus on day 5 of life. So it is always advisable to confirm the type of anorectal malformation both clinically and by doing required investigation before deciding for any operative intervention like colostomy or anoplasty, as clinical examination and investigation may not correlate in all occasions. Evaluation should also include screening out for associations and other sacral anomalies. BJHS 2018;3(2)6: 500-503.

An elderly man with fecal materials in the Foley catheter

A 70-year-old man presented to the emergency department with a 2-week history of watery diarrhea. Fecal materials were found in the Foley catheter. A computed tomography of the abdomen and pelvis revealed chronic diverticulitis with enterovesical fistula. The patient was treated with broad-spectrum antibiotics and underwent an urgent surgery with a transverse loop colostomy. The presence of fecaluria should raise the clinical suspicion of enterovesical fistula. Computed tomography is the choice of diagnostic modality.

A Case of Proximal Colon Bowel Volvulus after Low Anterior Resection for Rectal Cancer

Colonic volvulus is responsible for 4–5% of all cases of intestinal obstruction and most often found in the sigmoid colon, in elderly patients with chronic constipation, where patients develop a large redundant sigmoid colon and with a violation of diet. Twisting and compression of mesenteric blood vessels leads to disruption of intestinal wall nutrition followed by necrosis. Most cases of volvulus require the surgical treatment. Abdominal radiography (barium enema, MSCT) is frequently obtained as the initial diagnostic imaging and has characteristic appearances. We present a case of MRI diagnosis of the colon volvulus after the closure of the transverse loop colostomy after low anterior resection for rectal cancer. The cause of the volvulus was the twisting of the mobilized part of colon with the mesentery when it was lowered into the pelvis. The protective transverse loop colostomy caused the absence of clinical manifestations. After its closure patient was present the clinical features of bowel obstruction and the appearance of MR symptoms typical for this pathology. A retrospective analysis of MR tomograms obtained before the closure of the transverse loop colostomy, allowed revealing of signs of its subclinical ischemia. This case demonstrates the possibilities of MRI in identifying both the typical symptoms of colon volvulus and the signs indicating the possibility of colon twisting in patients after low anterior rectal resection, examined before closing the transverse loop colostomy.