Although the creation of a colostomy is often regarded as a minor surgical procedure, complications and underlying diseases associated with colostomy creation alter the quality of life and the life-style of the patient significantly. One hundred forty-five patients underwent a colostomy at the Department of Surgery, Kangnam Sacred Heart Hospital, between 1987 and 1996. There were 83 males and 62 females, with a mean age of 52 years (range: 1 year to 89 years). Sigmoid-end colostomies were performed most commonly (60.7%). The colostomies were performed predominantly for colorectal cancer (110 cases). Complications arising from the colostomy formation occurred in 45 patients (31%), with wound infection being the most common problem observed (16 cases). Colostomy revision was required in 4 cases. Patients with cecostomies had a relatively higher incidence of stomal complications (75%) when compared to those with other types of colostomies. Postoperative complications were more common after emergency operations than after elective operations. The complication rate for patients with obstructive colorectal cancer was higher than that of patients with non-obstructive colorectal cancer. Complications occurred in 3 patients of the 29 patients underwent colostomy closure(10.3%). The incidence of surgical complications was not related to the time interval between colostomy formation and closure. The mortality rate for colostomy formation was 2.7%, and the most common cause of death was sepsis. These results suggest that careful attention to technical details and intraoperative care in the case of emergency colostomy formation for obstructive colorectal cancer are necessary to reduce the risk of postoperative complications.
Cause of Death ; Cecostomy ; Colorectal Neoplasms ; Colostomy* ; Emergencies ; Female ; Heart ; Humans ; Incidence ; Intraoperative Care ; Male ; Mortality ; Postoperative Complications ; Quality of Life ; Sepsis ; Surgical Procedures, Minor ; Wound Infection

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. We present here a pictorial review of the imaging features and other factors involved in the diagnosis of these gastrointestinal complications in pediatric HSCT recipients.
Child ; *Diagnostic Imaging ; Gastrointestinal Diseases/*diagnosis/*etiology ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) refers to dilatation of the colon and decreased bowel motility without evidence of mechanical obstruction. Neostigmine, an acetylcholinesterase inhibitor, has been used in patients in whom supportive therapy failed to resolve ACPO. Here, we report the results of administering neostigmine to treat ACPO in children with hematologic malignancies. METHODS: Between September 2005 and December 2009, 10 patients (8 male and 2 female) were diagnosed with ACPO at the Department of Pediatrics, Catholic University of Korea. Diagnosis of ACPO was based on typical clinical features as well as colonic dilatation found on abdominal CT imaging. Neostigmine was administered subcutaneously at a dosage of 0.01 mg/kg/dose (maximum 0.5 mg) twice daily for a maximum of 5 total doses. ACPO was determined to be responsive to neostigmine if the patient showed both stool passage and improvement of clinical symptoms. RESULTS: The study group included 8 acute lymphoblastic leukemia patients, 1 patient with malignant lymphoma, and 1 patient with juvenile myelomonocytic leukemia. The median age at ACPO diagnosis was 8.5 years (range, 3-14). Overall, 8 patients (80%) showed therapeutic response to neostigmine at a median of 29 hours after the initial administration (range, 1-70). Two patients (20%) showed side effects of grade 2 or above, but none complained of cardiovascular symptoms that required treatment. CONCLUSION: In this study, ACPO was diagnosed most often in late-childhood ALL patients. Subcutaneous neostigmine can be used to effectively treat ACPO diagnosed in children with hematologic malignancies without major cardiovascular complications.
Acetylcholinesterase ; Child ; Colon ; Colonic Pseudo-Obstruction ; Dilatation ; Hematologic Neoplasms ; Humans ; Korea ; Leukemia, Myelomonocytic, Juvenile ; Lymphoma ; Male ; Neostigmine ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma