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 SS  Vol.2 No.10 , December 2011
Technical Points Regarding New Enterostomy Formation for Incarcerated Stomal Prolapse in Loop Enterostomy
Abstract: Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.
Cite this paper: nullT. Okada, S. Honda, H. Miyagi and A. Taketomi, "Technical Points Regarding New Enterostomy Formation for Incarcerated Stomal Prolapse in Loop Enterostomy," Surgical Science, Vol. 2 No. 10, 2011, pp. 488-792. doi: 10.4236/ss.2011.210107.
References

[1]   B Chandramouli, K Srinivasan and N Ananthakrishnan, “Morbidity and Mortality of Colostomy and Its Closure in Children,” Journal of Pediatric Surgery, Vol. 39, No. 4, 2004, pp. 596-599. doi:10.1016/j.jpedsurg.2003.12.016

[2]   E. S. Golladay, F. Bernay and C. W. Wagner, “Prevention of Prolapse in Pediatric Enterostomas with Purse String Technique,” Journal of Pediatric Surgery, Vol. 25, No. 9, 1990, pp. 990-991. doi:10.1016/0022-3468(90)90244-4

[3]   J. G. Chandler and B. P. Evans, “Colostomy Prolapse,” Surgery, Vol. 84, No. 5, 1978, pp. 577-582.

[4]   I. H. Krasna, “A Simple Purse String Suture Technique for Treatment of Colostomy Prolapse and Intussusception,” Journal of Pediatric Surgery, Vol. 14, No. 6, 1979, pp. 801-802. doi:10.1016/S0022-3468(79)80269-9

[5]   M. Gauderer and R. Izant, “A Technique for Temporary Control of Colostomy Prolapse in Children,” Journal of Pediatric Surgery, Vol. 20, No. 6, 1985, pp. 653-655. doi:10.1016/S0022-3468(85)80017-8

[6]   M. T. Cheung, “Complication of an Abdominal Stoma: An Analysis of 322 Stomas,” Australian and New Zealand Journal of Surgery, Vol. 65, No. 11, 1995, pp. 808- 811. doi:10.1111/j.1445-2197.1995.tb00566.x

[7]   A. H. Al-Salem, C. Grant and S. Khawaja, “Colostomy Complications in Infants and Children,” International Surgery, Vol. 77, No. 3, 1992, pp. 164-166.

[8]   N. Patwardhan, E. M. Kiely, D. P. Drake, et al., “Colostomy for Anorectal Anomalies: High Incidence of Complications,” Journal of Pediatric Surgery, Vol. 36, No. 5, 2001, pp. 795-798. doi:10.1053/jpsu.2001.22963

 
 
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