Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery

Non-operative management of gallstone sigmoid ileus in a patient with a prostatic cancer

Gallstone ileus is an uncommon complication of calculus cholecystitis through the formation of a biliary enteric fistula. The risk of mechanical obstruction caused by gallstones is increased with its size, in addition to chronic constipation, neoplasm and diverticulitis, to name a few. Here, we present a case of an 89-year-old male patient who presented with signs of bowel obstruction, which was found to be a gallstone impacted in the sigmoid colon. Considering the patient's stable condition and his comorbidities, a conservative approach was opted including IV fluids, fleet enema and bowel rest. Colonoscopy was performed and confirmed the passage of the stone. With no consensus regarding the management, the literature emphasizes a tailored approach to each case considering all possible operative and non-operative approaches. Some reports show promising results with non operative management. Gallstone ileus remains a challenging case, and further studies for the best treatment modalities are needed.

Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction

Purpose

Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy.

Methods

Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared.

Results

The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43-65) than in the loop ostomy group (60 minutes; IQR, 40-107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9-23]; loop, 21 days [IQR, 14-37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021).

Conclusion

In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Minimally invasive colostomy with endoscopy as a novel technique for creation of a trephine stoma

The conventional approach of trephine stoma creation is associated with various limitations, including poor elevation of the sigmoid colon, misidentification of the target organs, and poor visualization of the operative field, which may require conversion to an open approach. Our study aimed to evaluate the safety, feasibility, and complications of minimally invasive colostomy with endoscopy (MICE), a new technique for trephine stoma creation. This retrospective cohort study included 14 patients. Patients diagnosed with obstructive rectal cancer or bladder and rectal disorders due to spinal cord injury or bone metastasis requiring sigmoid loop colostomy were eligible for the procedure. MICE was performed using a combination of endoscopic and fluoroscopic procedures. The primary endpoint was the technical success of MICE. Technical success using MICE was achieved in all 14 cases. The mean total operative time was 52.6 (range 32-107) min, and mean blood loss was 18.9 (range 1-50) mL. There was no incidence of conversion to open surgery. Postoperative complications included peristomal abscess formation and ischemic colitis in each case. MICE may be useful as a minimally invasive approach for trephine stoma creation that overcomes the problems of a conventional approach in high-risk patients.