OBJECTIVE: The aim of this study was to examine the clinical characteristics of patients with ovarian cancer who underwent enterostomy. METHODS: Via medical record review, we obtained clinical information of 51 ovarian cancer patients who underwent enterostomy in our hospital, from 1990 to 2006. We compared the clinical characteristics according to the indication of enterostomy: primary cytoreduction (PC), secondary cytoreduction (SC), and palliative only (PO). In addition, we investigated the correlations among clinical characteristics to find prognosticators. RESULTS: Patients were older (P=0.061), had less upper gastrointestinal symptoms (P=0.000), underwent colostomy rather than ileostomy (P=0.037), and received more postoperative chemotherapy (P=0.000) according to the following order: PC, SC, PO groups. Older patients had more postoperative complications (P=0.035). In the PC group, older patients had less chance of optimal debulking (P=0.020). In the PO group, preoperative gastrointestinal symptoms were associated with the type of enterostomy. CONCLUSIONS: Clinical characteristics of patients were different according to the indication of enterostomy. Careful examination of clinical characteristics and gastrointestinal symptoms might be helpful to predict the postoperative quality of life.
Colostomy ; Enterostomy ; Humans ; Ileostomy ; Medical Records ; Ovarian Neoplasms ; Palliative Care ; Postoperative Complications

Leveling colostomy with a frozen-section biopsy in a Hirschsprung's disease is an important factor for a successful procedure. Two neonatal cases of Hirschsprung's disease in the descending colon are reported. In both cases, loop ileostomy was established because of the unavailability of frozen-section biopsy on an emergency basis. At the time of definitive procedure of the first case, transition zone at the splenic flexure was noted and was compatible with the frozen section biopsy. In the second case, an unexpected longer resection at a higher level than transition zone was required because of the poor vascularity after dissection. In conclusion, a leveling colostomy should be selected as a choice in long-segment Hirschsprung's disease. Confirming preservation of the marginal artery of Drummond is particularly important in case of Hirschsprung's disease in the descending colon.
Arteries ; Biopsy ; Colon, Descending* ; Colon, Transverse ; Colostomy ; Emergencies ; Enterostomy ; Frozen Sections ; Hirschsprung Disease* ; Ileostomy

Objective: To investigate the efficacy and safety of diseased bowel resection and diversion enterostomy in the treatment of late severe complications of chronic radiation-induced late rectal injury (RLRI). Methods: Studies about comparison of diseased bowel resection and diversion enterostomy in the treatment of late severe complications of chronic RLRI were screened and retrieved from databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, CNKI, VIP, CBM and Wanfang. The following terms in Chinese were used to search [Title/Abstract]: radiation-induced intestinal injury, radiation proctitis, surgery. The following English terms were used to search: Radiation-induced intestinal injury, Bowel injury from radiation, Radiation proctitis, Surgery, Colostomy. Literature inclusion criteria: (1) studies with control groups, published at home and abroad publicly, about the postoperative effects of diseased bowel resection vs. diversion enterostomy on RLRI patients with late severe complications; (2) the period of the study performed in the literatures must be clear; (3) patients at the preoperative diagnosis for RLRI with refractory bleeding, narrow, obstruction, perforation or fistula, etc.; (4) diseased bowel resection included Hartmann, Dixon, Bacon and Parks; diversion enterostomy included colostomy and ileostomy; (5) if the studies were published by the same institution or authors at the same time, the study with the biggest sample size was chosen; studies conducted in different time with different subjects were simultaneously included; (6) at least one prognostic indicator of the following parameters should be included: the improvement of symptoms, postoperative complications, mortality, and reversed stomas rate. The stoma reduction rate was defined as the ratio of successful closure of colostomy after diseased bowel resection and diversion enterostomy. The method of direct calculation or the method of convert into direct calculation were used for stoma reduction rate. Exclusion criteria: (1) a single-arm study without control group; (2) RLRI patients did not undergo diseased bowel resection or diversion enterostomy at the first time; (3) RLRI patients with distant metastasis; (4) the statistical method in the study was not appropriate; (5) the information was not complete, such as a lack of prognosis in the observational indexes. After screening literatures according to criteria, data retrieval and quality evaluation were carried out. Review Manager 5.3 software was used for Meta-analysis. Sensitivity analysis was used to exam the stability of results. Funnel diagram was used to analyze the bias of publication. Results: A total of 11 literatures were enrolled, including 426 RLRI patients with late severe complications, of whom 174 underwent diseased bowel resection (resection group) and 252 underwent diversion enterostomy (diversion group), respectively. Compared with diversion group, although resection group had a higher morbidity of complication (35.1% vs. 15.9%, OR=2.67, 95% CI: 1.58 to 4.53, P<0.001), but it was more advantageous in symptom improvement (94.2% vs. 64.1%, OR=6.19, 95% CI: 2.47 to 15.52, P<0.001) and stoma reductions (62.8% vs. 5.1%, OR=15.17, 95% CI: 1.21 to 189.74, P=0.030), and the differences were significant (both P<0.05). No significant difference in postoperative mortality was found between the two groups (10.1% vs. 18.8%, OR=0.74, 95% CI: 0.21 to 2.59, P=0.640). There were no obvious changes between the two groups after sensitivity analysis for the prognostic indicators (the symptoms improved, postoperative complications, mortality, and reversed stomas rate) compared with the meta-analysis results before exclusion, suggesting that the results were robust and credible. Funnel diagram analysis suggested a small published bias. Conclusions: Chronic RLRI patients with late severe complications undergoing diseased bowel resection have higher risk of complication, while their long-term mortality is comparable to those undergoing diversion enterostomy. Diseased bowel resection is better in postoperative improvement of symptoms and stoma reduction rate.
Colostomy ; Enterostomy ; Humans ; Ileostomy ; Radiation Injuries/surgery* ; Rectum/surgery* ; Surgical Stomas

BACKGROUND: Afferent loop syndrome is an uncommon complication of a gastric resection in which intestinal continuity has been restored by using a gastrojejunostomy. It may cause symptoms at any time from the first postoperative day to many years after the gastrectomy, although most symptoms are manifestated during the second postoperative week. Due to difference in the degree and the permanence of the obstruction, the symptoms and the courses of patients with afferent loop syndrome may be acute or chronic. METHODS: We performed a retrospective clinical analysis of 29 patients who had been treated with operations from January 1982 to December 1996 at the Department of Surgery, Catholic University Medical Center. RESULTS: Afferent loop syndrome occurred in 29 cases (0.46%) of gastric surgery involving 1882 peptic-ulcer cases and 4390 stomach cancer cases. The original conditions requiring gastric surgery were gastric ulcers (8/752, 1.06%), duodenal ulcers (10/1130, 0.88%), and stomach cancer (11/4390, 0.25%). This syndrome occurred more frequently for a truncal vagotomy and a Billroth II type antrectomy (1.76%) than for other surgical procedures. The etiologic factors of afferent loop syndrome were an adhesive band (41.4%), volvulus (24.1%), retroanastomotic internal herniation (20.7%), and stomal stenosis (13.8%). The time interval from the first operation to the onset of symptoms was less than two weeks in 58.6% of the patient. Epigastric pain was the most common symptom (93.1%), followed by nausea and/or vomiting (51.7%), tachycardia (41.3%), and fever (27.5%). The diagnostic procedure mainly performed was an upper gastrointestinal series (69%). Hyperamylasemia was noted in 17 patients (65%). Theoperations performed included a bypass jejunojejunostomy in 17 patients (58.6%), a Roux-en-Y enterostomy in 6 patients (20.7%), a tube duodenostomy in 2 patients (6.9%), a bypass jejunostomy with tube duodenostomy in 2 patients, and a pancreaticoduodenectomy in 2 patients. The postoperative complications were wound infections (34.5%), pleural effusion (13.8%), enterocutaneous fistulas (17.2%), and subphrenic abscesses (13.8%). The operative mortality rate (within 2 months) was 13.8%. CONCLUSIONS: If afferent loop syndrome is suspected, it may be demonstrated by using an upper gastrointestinal contrast study. Endoscopy should be performed in all patients in whom the diagnosis of afferent loop obstruction is suspected. It's main value is to rule out other causes for the patient's complaints, especially in alkaline reflux gastritis. Once the diagnosis is made, surgical correction is indicated. The most satisfactory measure to prevent afferent loop syndrome is to avoid a long afferent loop. If a Billroth I or a Roux-en-Y pattern gastrointestinal anastomosis is difficult, this complication is best avoided by using a short afferent loop and by fashioning the anastomosis to prevent an obstruction at the stoma.
Academic Medical Centers ; Adhesives ; Afferent Loop Syndrome* ; Constriction, Pathologic ; Diagnosis ; Duodenal Ulcer ; Duodenostomy ; Endoscopy ; Enterostomy ; Fever ; Gastrectomy ; Gastric Bypass ; Gastritis ; Gastroenterostomy ; Humans ; Hyperamylasemia ; Intestinal Fistula ; Intestinal Volvulus ; Jejunostomy ; Mortality ; Nausea ; Pancreaticoduodenectomy ; Pleural Effusion ; Postoperative Complications ; Retrospective Studies* ; Stomach Neoplasms ; Stomach Ulcer ; Subphrenic Abscess ; Tachycardia ; Vagotomy, Truncal ; Vomiting ; Wound Infection

This is a 20 year analysis of the problems associated with enterostomy formation, and closure. Forty-three stomas were established in 43 patients: 23 for anorectal malformations, 11 for Hirschsprung's diseases, 4 for necrotizing enterocolitis, 3 for multiple ileal atresias, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. Thirty boys and 13 girls were included (mean age 4.8 months). Stoma complications were encountered in 13 patients (30.2 %): stomal prolapse, stenosis, obstruction, paracolic hernia, retraction, dysfunction, and skin excoriation. Four patients (9.3 %) required stomal revision. Occurrence of complications was not related to age and primary disease, but sigmoid colostomy showed lower complication rate than transverse colostomy (20.0 % vs 42.9 %, p<0.05). There were five deaths but, only one (2.3 %) was directly related to the enterostomy complication. Twenty-one stomas were closed in our hospital and complications occurred in seven patients (33.3 %). The most common complication was wound sepsis in 5 children. In conclusion, because the significant morbidity of stomal formation still exists, refinements of the surgical technique seem to be required. Sigmoid loop colostomy is preferred whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Enterostomy ; Female ; Hernia ; Hernia, Diaphragmatic ; Humans ; Intestinal Volvulus ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

Peutz-Jeghers syndrome is an autosomal dominant inherited syndrome characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyps. The most important complications that increase morbidity are intussusception, bleeding and obstruction. Most patients with Peutz-Jeghers syndrome may undergo multiple laparotomies for complications such as intussusception or bleeding every 2 to 3 years during adolescence and early adulthood. To decrease the relaparotomy rate, intraoperative endoscopy may be useful in the treatment of complications that are related to Peutz-Jeghers syndrome. Use of intraoperative endoscopy can lead to a healthier life and to a longer life expectancy for the patient. We describe a case of Peutz-Jeghers syndrome, who underwent polypectomy by total gut endoscopy in an 11-year-old girl presented with intestinal obstruction and anemia. During the course of the operation, the endoscope was inserted per the enterostomy and colostomy sites, and 16 polyps in the small and large intestine were removed endoscopically using a snare.
Adolescent ; Anemia ; Child* ; Colostomy ; Endoscopes ; Endoscopy* ; Enterostomy ; Female ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intestine, Large ; Intussusception ; Laparotomy ; Life Expectancy ; Peutz-Jeghers Syndrome* ; Pigmentation ; Polyps ; SNARE Proteins

Enterocolitis associated with Hirschsprung's disease has been a major cause of morbidity and even mortality, and before and after definitieve surgical treatment. It shows typical clinical characteristics, however, its pathogenesis has been poorly understood. Treatment is diverse, and consists of conservative tertment with intravenous hydration, antibiotics and rectal wash out, and surgical tertment with temporatory enterostomy, and other surgical procedures.
Anti-Bacterial Agents ; Enterocolitis* ; Enterostomy ; Hirschsprung Disease* ; Mortality

performed at the time of discharge. There was only one recurrence of adirect inguinal hernia. Necrotizing enterocolitis developed in 17 patients, 11 were operated upon, two had peritoneal drainages, and 9 had enterostomies. Five of 11 surgical infants died after operation and three of the nonsurgical infants died of various complications. Although micropremies have potentially high risks of serious complications and death, the outcome can improve with careful surgical observation and judgment.
Enterocolitis ; Enterocolitis, Necrotizing ; Enterostomy ; Hernia, Inguinal ; Humans ; Infant ; Judgment ; Recurrence

performed at the time of discharge. There was only one recurrence of adirect inguinal hernia. Necrotizing enterocolitis developed in 17 patients, 11 were operated upon, two had peritoneal drainages, and 9 had enterostomies. Five of 11 surgical infants died after operation and three of the nonsurgical infants died of various complications. Although micropremies have potentially high risks of serious complications and death, the outcome can improve with careful surgical observation and judgment.
Enterocolitis ; Enterocolitis, Necrotizing ; Enterostomy ; Hernia, Inguinal ; Humans ; Infant ; Judgment ; Recurrence

Stoma is a commonly used surgical procedure in clinic practice. However, for obese patients with thick abdominal wall, short and thickened mesentery, and for patients with intestinal obstruction and abdominal distension (difficult stoma), establishing a tension- free and well blood-supplied stoma is still a great challenge. Careful preoperative planning, including stoma location marking, careful consideration of all alternatives and attention to technical details, will help to make an optimal stoma under challenging conditions. For enterostomy of obese patients, the pullout intestine must be free of tension and must have sufficient blood supply, the structure of the abdominal wall should be incised vertically, and the intestine should be pulled out vertically as well. For enterostomy of patients with intestinal obstruction, the diameter of the stoma incision should not exceed 3 cm to avoid parastomal hernia, which commonly occurs after bowel retraction.
Humans ; Surgical Stomas ; Incisional Hernia ; Enterostomy ; Intestinal Obstruction ; Obesity