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Colostomy formation and closure
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
In 1783, Dubois is said to have been the first to construct a colostomy in an infant, but the patient, who had anal atresia, died after 10 days. The first long-term survivor was an infant, also with imperforate anus, who had a colostomy made by Duret in 1793 and was still alive 45 years later. During the 19th century, the procedure was introduced at centers across Europe and various modifications were developed, including loop colostomy over a rod by Maydl (1888). Operation “a deux temps” reported in 1885 by Davies-Colley of Guy's Hospital, London, consisted of suturing the bowel to the skin followed by delayed opening once the wound edges had sealed; this was an important development in an era when infection was the major cause of morbidity. The Hartmann procedure, described in 1923 for use following rectal excision for carcinoma at a time when anastomosis of the colon to the rectum was still dangerous, is still widely used in pediatric surgery.
Stomas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
John R.T. Monson, Iain Andrew Hunter
Data from 2002 confirm the much higher overall morbidity following closure of an end colostomy (48%) compared with closure of a loop−sigmoid (13%) or transverse colostomy.130 Details of the morbidity of restoring intestinal continuity after the Hartmann procedure are found in Chapter 52.
Single incision laparoscopic colorectal surgery
Published in Mark Coleman, Tom Cecil, Brian Dunkin, Laparoscopic Colorectal Surgery, 2017
Reversal of Hartmann procedure through colostomy site by this technique was first described as a case series of five patients in 2011, and I would like to call it a North Tees technique of reversal. The end colostomy (Photo 16.22) is fully mobilised from skin and abdominal wall (Photo 16.23). The anvil of circular stapler gun is inserted after excising the end of colostomy and colon end is put back inside abdomen with the anvil. A multichannel port is inserted through the colostomy site (Photo 16.24). All adhesions to anterior abdominal wall are divided (Photo 16.25). Small bowel loops are taken out of the pelvis after dividing adhesions. Rectal stump is defined and assessed to confirm that a circular stapling gun through the anus will reach to the end of it. The left colon is mobilised and adhesions to omentum and small bowel loops are divided. Stapled colorectal anastomosis is done once the surgeon is happy with the length of the mobilised colon (Photo 16.26). The stoma site is then closed with appropriate sutures.
Clinical outcome of decompressing colostomy for acute left-sided colorectal obstruction: a consecutive series of 100 patients
Published in Scandinavian Journal of Gastroenterology, 2022
Jelle F. Huisman, Job W. A. de Haas, Richard M. Brohet, Frank P. Vleggaar, Wouter H. de Vos tot Nederveen Cappel, Henderik L. van Westreenen
Elective segmental colon resection was performed in 59 of 100 patients (59%) (Table 3). Eight of these 59 patients (14%) underwent resection with primary anastomosis and simultaneous DC reversal and another 8 patients underwent resection with simultaneous closure of the DC and creation of an end colostomy (Hartmann procedure). For the remaining 41 patients, elective resection was not performed in 39 patients and 2 patients were lost to follow up (Figure 1). The median hospital stay after elective resection was 5 days [range 2–53] and the median time between DC and colonic resection was 10 weeks [range 2–60]. Forty-three patients (73%) were planned for laparoscopic resection. Laparoscopy was converted to an open procedure in 12 of these patients, because of complex diverticulitis (n = 8), or multivisceral resections for cT4 tumors (n = 4). A primary open procedure was planned in 16 patients. The morbidity rate after resection was 20%; minor morbidity in 11 patients and major morbidity 1 patient (pulmonary embolism requiring admission to intensive care). Mortality occurred in 1 patient (2%).
Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center
Published in Acta Chirurgica Belgica, 2022
Julie Frezin, Julie Navez, Paryse Johnson, Philippe Bouchard, Sébastien Drolet
The postoperative mortality rate was 29% (12/42), including 9 and 3 patients in emergency and elective settings, respectively (p = .359), with a median time to death of 15 days (8–24). The causes of death within 30 days were postoperative refractory shock (n = 2), early postoperative respiratory insufficiency (n = 1), cardiogenic shock (n = 2), septic shock (n = 3) including one with peritonitis from anastomotic leak (n = 1), terminal renal insufficiency due to patient’s desire to discontinuate hemodialysis after myocardial infarction (n = 1), and spinal cord ischemia (n = 1). Two other patients died after the 30 days, including one on postoperative day 78 after right open colectomy who needed reintervention for intraabdominal hemorrhage, then pulmonary edema, pneumonia, abdominal sepsis, wound infection, and at the end discontinuation of care according to patient’s will. The other one died on postoperative day 106 following elective Hartmann procedure for diverticulitis, which developed multiple complications including postoperative bleeding, femoral pseudoaneurysm, perirenal hematoma, abdominal sepsis, Clostridium Difficile colitis, pericardial effusion and disseminated intravascular coagulation. The median postoperative length of stay was 14.5 days (8–42), and similar between elective and emergency groups (p = .946). Ten patients were hospitalized for more than 30 days.
Recurrent neutropenia and chronic diarrhea following thymectomy: the good, the bad, and the ugly
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Mosunmoluwa Oyenuga, Safia Shaikh, Benjamin Harris, Jyotsana Sinha, Alexandre Lacasse
The following year, the patient was hospitalized for severe non-granulomatous colitis mimicking inflammatory bowel disease causing large bowel obstruction which responded to endoscopic decompression, corticosteroid therapy, and empiric antimicrobial therapy. Soon thereafter, the patient presented in gram-negative septic shock with bacteremia due to perforated sigmoid diverticulitis in the context of severe neutropenia. He underwent Hartmann procedure with colostomy. Neutropenia recovery was seen with IV antibacterial treatment. Four months later, recurrent colitis and rhinovirus upper respiratory tract infection along with profound neutropenia led to another hospitalization. HIV screening test, stool ova and parasites, stool culture and Clostridium difficile toxin, and PCR were negative. Bone marrow biopsy was consistent with regenerative benign marrow. Neutropenia recovery was again observed with antibacterial treatment (Figure 2).