Surgical methods of treatment of intestinal passage disturbances with the characteristics of constipation in patients with intestinal stoma based on own experience
Languages of publication
Stoma is an intestinal fistula created in emergency or by elective indications, and it is done to drain out the digestive tract content. In some patients there is a disturbance passage of gastric contents through the stoma, which may take the form of chronic constipation or even periodic subileus that will sooner or later require surgical treatment. The aim of the study was the assessment of the causes and method of treatment of constipation in patients with intestinal stoma. Material and methods. A total of 331 patients with stoma followed by Ostomy and Proctology Outpatient Clinic were included in the study in the years 2011-2014. The study included 146 women and 185 men and the average age was 61.3 ± 12.7 years. Within the entire froup, 273 patients had the end stoma performed whereas in 58 patients the loop stoma was created. The highest percentage of patients were the ones with diverticulosis and colorectal cancer, i.e. 132 and 114 patients respectively. A stoma was created in 35 patients due to inflammatory bowel disease (IBD), in 23 patients because of cancer, in 14 as a result of injuries and in 13 due to rectovaginal fistula. Results. Out of the entire group subject to study (331 patients) 93 patients (28.1%) suffered from constipation. 50 patients with constipation required surgical intervention. The most common indication for surgical treatment was the parastomal hernia (36 patients, 72%), other indications were the narrowing of the stoma (5 patients, 10%), its collapse (6 patients, 12%) or prolapse (3 patients, 6%). Parastomal hernia was responsible for 84% of constipation within the stoma and 86.1% were treated with laparotomy (31 out of 36 patients). Other causes of constipation were the stomal stenoses (5 patients), collapse of the stoma (6 patients) and stomal prolapse (3 patients). All patients were treated surgically with a good final result. Conclusions. Constipation associated with dysfunction of the stoma in most cases should be treated surgically. Parastomal hernia is the most common cause of constipation in the stoma. Treatment should be performed in due time because of the possibility of developing complications, especially dangerous one is a strangulated parastomal hernia and ischemia of stoma.
1 - 4 - 2015
27 - 3 - 2015
3 - 7 - 2015
- 1. Hyland J: The basic of ostomies. Gastroenterol Nurs 2002; 25: 241-44.
- 2. Brand MI, Dujovny N: Preoperative considerations and creation of normal ostomies. Clin Colon Rectal Surg 2008; 21: 5-16.
- 3. Bharucha AE, Pemberton JH, Locke GR 3rd: American Gastroenterological Association technical review on constipation. Gastroenterology 2013; 144: 218-38
- 4. American Gastroenterological Association, Bharucha AE, Dorn SD, Lembo A, Pressman A: American Gastroenterological Association medical position statement on constipation. Gastroenterology 2013; 144: 211-17.
- 5. Krokowicz L, Stojcev Z, Kaczmarek BF et al.: Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis - a prospective randomized study. Int J Colorectal Dis 2014; 29: 387-93.
- 6. Arumugam PJ, Bevan L, Macdonald L et al.: A prospective audit of stomas - analysis of risk factors and complications and their management. Colorectal Dis 2003; 5: 49-52.
- 7. Pilgrim CH , McIntyre R, Bailey M: Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 2010; 53: 71-76.
- 8. Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M: Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 2011; 148: e435-e441.
- 9. Carne PW, Robertson GM, Frizelle FA : Parastomal hernia. Br J Surg 2003; 90: 784-93.
- 10. Gil G, Szczepkowski M: A new classification of parastomal hernias - from the experience at Bielański Hospital in Warsaw. Pol Przegl Chir 2011; 83: 430-37
- 11. Londono-Schimmer EE, Leong AP, Phillips RK : Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994; 37: 916-20.
- 12. Nastro P, Knowles CH , McGrath A et al.: Complications of intestinal stomas. Br J Surg 2010; 97: 1885-89.
- 13. Beraldo S, Titley G, Allan A: Use of W-plasty in stenotic stoma: a new solution for an old problem. Colorectal Dis 2006; 8: 715-16.
- 14. Leong APK, Londono-Schimmer EE, Philips RKS : Life table analysis of stomal complications following ileostomy. Br J Surg 1994; 81: 727-29.
- 15. Robertson I, Eung E, Hughes D et al.: Prospective analysis of stoma related complications. Colorectal Dis 2005; 7(3): 273-85.
- 16. McErlain D, Kane M, McMgrogan M, Haughey S: Proapsed stoma. Nurs Stand 2004; 18: 41-42.
- 17. Shellito PC: Complications of abdominal stoma surgery. Dis Colon Rectum 1998; 41: 1562-72.
Publication order reference