Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as...Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.展开更多
It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placeme...It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.展开更多
文摘Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.
文摘It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.
