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A 54-year-old male patient presented with pneumaturia. Right scrotal swelling was observed. CT showed an intrascrotal abscess with gas formation. MRI showed a fistula extending from the sigmoid colon to the seminal vesicles. Since there are many diverticula in the sigmoid colon, an abscess caused by diverticulitis may have formed a fistula. The scrotal abscess was drained; however, the pus discharge did not decrease. A colostomy was then performed, and the scrotal infection rapidly improved. Sigmoidectomy and fistula transection were performed 11 months after the colostomy. Prompt diagnosis of a sigmoid coloseminal fistula using imaging has led to optimal treatment.

Key clinical message Congenital anorectal malformation (ARM) is a diverse group of anomalies affecting the development of the anal and rectal regions, with an estimated incidence of one in every 5000 live births. The colostomy is commonly performed as part of the staged management of children with ARM to prevent complications. However, the presence of acute watery diarrhea in children with ARM and colostomy poses significant management challenges due to the altered anatomy and physiology affecting stool regulation and absorption, exacerbated by various factors including infections, dietary issues, medication side effects, and underlying gastrointestinal complications.This case study explores the complexities involved in managing acute watery diarrhea in children with congenital ARM and colostomy. A comprehensive literature review was conducted to examine the existing evidence on the subject. The study highlights the multidisciplinary approach required, involving pediatricians, surgeons, and other specialists, to provide comprehensive care and support for these children. Effective management of acute watery diarrhea in children with congenital ARM and colostomy necessitates collaboration between pediatricians and surgeons. Pediatricians play a crucial role in assessing hydration status, monitoring electrolyte balance, and providing appropriate fluid and nutritional management. Surgeons address the surgical aspects of care and coordinate interventions with the management of acute diarrhea. The study underscores the importance of a multidisciplinary approach to deliver comprehensive care, optimize outcomes, and improve the quality of life for affected children. The management of acute watery diarrhea in children with congenital ARM and colostomy presents significant challenges due to the complex interplay of anatomical, physiological, and clinical factors. A multidisciplinary approach involving pediatricians, surgeons, and other specialists is vital for providing comprehensive care and support. This case study emphasizes the need for further research, guidelines, and collaborative efforts to enhance the management strategies for this vulnerable population.

Background. Despite the many studies conducted, the problem of choosing the prevention of parastomal hernias remains relevant. Nowadays, no studies have been presented in the available literature on the timing of the parastomal hernias formation after removal of the colostomy and localization of the hernia in the projection of the intestinal stoma. The purpose of this study is to evaluate the results of stoma treatment to establish the average time of formation of parastomal hernia and its localization in the projection of the intestinal stoma. Materials and methods. The analysis of 22 patients with various abdominal surgical pathology requiring removal of a colostomy in 2017‒2022, who subsequently developed a parastomal hernia, was carried out. Results. The study did not establish a statistically significant difference in the timing of the formation of parastomal hernia. A statistically significant difference was obtained among patients with different localization (lateral-caudal and circular location) (p < 0.05) of parastomal hernia. Conclusions. The revealed fact of the formation of parastomal hernias in the absolute majority of cases, lateralcaudal localization, directs the surgeon to perform preventive measures to further strengthen this zone in order to prevent hernias during the formation of a colostomy.

Background: Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy. Methods: A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded. Results: Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed. Conclusion: High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation. [ABSTRACT FROM AUTHOR]

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications. [ABSTRACT FROM AUTHOR]

Aim: Self‐efficacy in stoma care is essential, as it reduces morbidity and psychosocial problems. Mobile applications (apps) may optimise patients' self‐efficacy. This article investigates patients' satisfaction with stoma care, their attitudes towards a supporting app aiming to promote self‐efficacy and evaluate which functionalities are desired. Method: A survey was sent to members of the two stoma‐related patient associations in the Netherlands. Associations between patient characteristics, satisfaction concerning received stoma care, and willingness to use an app were evaluated. Results: The survey was completed by 1868 patients. Overall satisfaction was scored as 6.6, with shortfalls reported in the preoperative information provision, stoma site selection, and postoperative care. Patients of older age, who were unaware of getting a stoma, had an ileostomy, a low quality of life or psychosocial problems, were less satisfied. An app was expected to be of added value by 59.4% of the patients having a stoma for less than three years, compared to the significantly lower 43.8% expectation rate of the remaining study population (p < 0.001). Moreover, patients with a high frequency of physical or psychosocial problems expressed higher levels of interest. Conclusion: Patients were only moderately satisfied with their received stoma care. A supportive app is most likely beneficial for patients who had a stoma for less than three years, were in an acute situation, and/or have stoma‐related problems. Most patients prefer information via internet or on paper, although apps may offer additional benefits. It is important to acknowledge digital literacy and to council patients appropriately about the benefits and help them to use apps. [ABSTRACT FROM AUTHOR]

Background: Conventionally, oral feeds after distal bowel anastomosis surgery (ileostomy/colostomy closure) are delayed until after bowel peristalsis is established. The safety of an early feeding regimen is not established in children. This study compared early feeding regimens with delayed feeding in children undergoing elective intestinal anastomosis surgeries. Materials and Methods: In this retrospective multicentric cohort study, children undergoing elective distal bowel anastomosis surgery were divided into Group A (oral feeds allowed within 6 h) and Group B (delayed feeds). The two groups were compared for the incidence of abdomen distension, vomiting, surgical site infection, duration of analgesia, length of hospital stay, and readmission rate. Results: During the study, 58 patients were included: Group A (n = 26) and Group B (n = 32). The duration of analgesia (1.9 vs. 4.01 days) and length of hospital stay (3.38 vs. 5.0 days) were significantly less in Group A. Abdominal distension (7.7% vs. 15.6%), vomiting (11.5% vs. 15.6%), surgical site infection rate (3.8% vs. 12.5%), and readmissions (0% vs. 3.1%) were less in Group A, but statistically not significant. Conclusion: Early feeding after the elective restoration of distal bowel continuity can be safely practiced in the pediatric population. It is associated with a reduced need for analgesia and shorter hospital stay. [ABSTRACT FROM AUTHOR]

The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to review the available evidence and provide expert advice regarding the management of patients with an enteral stoma. This CPU was commissioned and approved by the AGA Institute Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of a multidisciplinary group of authors composed of gastroenterologists, a colorectal surgeon, a wound ostomy and continence nurse, and ostomate. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term. Background: A PSH is the most frequent complication after stoma formation. Prophylactic placement of a mesh has been suggested to prevent PSH, but long-term evidence to support this approach is scarce. Methods: In this multicentre superiority trial patients undergoing the formation of a permanent colostomy were randomly assigned to either retromuscular polypropylene mesh reinforcement or conventional colostomy formation. Primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life, and cost-effectiveness. Results: A total of 150 patients were randomly assigned to the mesh group (n = 72) or nonmesh group (n = 78). For the long-term follow-up, 113 patients were analyzed, and 37 patients were lost to follow-up. After a median follow-up of 60 months (interquartile range: 48.6–64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the nonmesh group (P = 0.22; RD: −9.4%; 95% CI: −24, 5.5). The cost related to the meshing strategy was € 2.239 lower than the nonmesh strategy (95% CI: 491.18, 3985.49), and quality-adjusted life years did not differ significantly between groups (P = 0.959; 95% CI: −0.066, 0.070). Conclusions: Prophylactic mesh placement during the formation of an end-colostomy is a safe procedure but does not reduce the incidence of PSH after 5 years of follow-up. It does, however, delay the onset of PSH without a significant difference in morbidity, mortality, or quality of life, and seems to be cost-effective. [ABSTRACT FROM AUTHOR]

Bowel management in the person with a permanent colostomy is important and the burden of continuous use of bags and adapters (base plates / skin barriers) on health care costs and the environment is known. When applied regularly, colostomy irrigation (CI) contributes to improving the quality of life (QOL) of the individual with a permanent colostomy by enabling improved faecal continence and reducing costs. The aim of this article was to examine the positive impact of CI on an individual's QOL and health expenditures. In this case, it was found that a patient with a permanent colostomy who had performed CI for 21 years could eliminate many of the physical and psychological problems as well as peristomal skin complications (PSCs), arising from using a colostomy appliance only. It was also determined in this case scenario that bowel management using CI was three times more cost-effective than the colostomy bag system. [ABSTRACT FROM AUTHOR]

Megalourethra is a rare clinical entity of absence or hypoplasia of corpus spongiosum and/or corpora carvenosa or anterior urethral valve along the pendulous urethra causing enlarged penis as a result of cystic dilatation of this part mostly during passage of urine. It may be associated with other congenital anomalies such prune belly syndrome and imperforated anus among others. We present a 10-day old neonate with scaphoid megalourethra associated with imperforated anus and pyloric stenosis. To the best of our knowledge, wehave limitedinformation on megalourethra in most parts of Africa but also, we were unable to find out any published report in East Africa regarding this rare condition especially in association with pyloric stenosis and imperforated anus. [ABSTRACT FROM AUTHOR]

Aim: In cases such as colostomies, enterocutaneous fistulas and catheters leaking fluid from the environment; the use of stoma bags is necessary. The aim of this study; it is to present the invention called "stoma bag cover" that can be used instead of laborious applications such as opening the stoma bag completely to make an enema or puncturing the bag for drainage. Material and Methods: Stoma bag cover is a cover that can be placed in the anterior middle part of the stoma bags and provides an opening through which catheters can come out. In addition, in order to prevent leakage around the drain, there is a nylon structure prepared with a purse-shaped thread around the inside of the cover. By knotting this nylon structure after the drain or catheter is passed through the thread at the end, the space that will cause leakage around the drain is eliminated. In addition, if the need for the opening in the stoma bag ends, the cover is designed to be closed and leakproof. Results: Stoma bag cover; it provides a more practical and effective mechanism for applications that are sometimes insufficient to prevent leakage, such as tying and taping applied to drains removed from the stoma bag. In addition, this invention is a valve mechanism that can enable some necessary applications without opening the stoma bag completely without contamination. Conclusion: It is expected that this invention will provide healthier results and comfort compared to previous applications, both by providing ease of application and reducing contamination. [ABSTRACT FROM AUTHOR]

Background: Most patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction. Methods: This prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 (http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to "Endoscopic Group (EG)" or "Surgical Group (SG)" via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention. Results: Sample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation. Conclusion: Endoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus). [ABSTRACT FROM AUTHOR]

Background: Several imaging modalities are available to assess complications post intestinal stoma creation. The aim of this study was the radiological assessment of intestinal complications pre-stomal closure using routine fluoroscopic water-soluble contrast enema (WSCE), combined CT-WSCE, and MRI-enema with rectal gel administration. Additionally, we aimed to investigate the potential alterations in the surgical management plan based on imaging findings. Results: This prospective cross-sectional study recruited 130 patients with stomas referred for the assessment of stoma integrity. Thirty-six patients with stoma-related intestinal complications were included. Patients with complications were subdivided into 3 groups. Group A 15 patients with intestinal stomas referred for WSCE pre-stomal closure and complementary CT-WSCE evaluation was performed. Comparison between the detection of the complications by WSCE alone and combined CT-WSCE among group A was statistically significant (p = 0.008) yet the alteration of the surgical plan based on both modalities was not statistically significant (p = 0.063). Group B 11 patients with poor general conditions were referred directly for combined CT-WSCE assessment, complications diagnosed in this group: 6 (54.5%) intestinal obstruction, 2 (18.2%) pericolic collections, 2 (18.2%) abnormal fistula and 1 (9.1%) anastomotic leak. Group C 10 patients with intestinal stomas with malignant or inflammatory conditions referred directly for MRI-enema assessment, showed complications as follows: 3 (30%) colon/rectal tumoral recurrence, 2 (20%) strictures, 2 (20%) pericolic collections and 3 (30%) abnormal intestinal fistulous communications. Comparison between complicated colorectal cancer patients (20 patients) versus other complicated patients secondary to other surgical indications (16 patients) enrolled in the study from the 3 different groups was not statistically significant (p = 0.125). Conclusions: Combined CT and WSCE is superior in the detection of intestinal fistulas, peri-colic collections, tumor recurrence, and para-stomal hernias than WSCE alone and might lead to a change of management. MRI after rectal gel administration can serve as reliable substitute in some patients for the detection of intestinal complications namely fistulas and tumor recurrence. [ABSTRACT FROM AUTHOR]

Background: Preventive colostomy is required for colorectal surgery, and the incidence of complications associated with ileostomy and colostomy remains controversial. This study aimed to compare the incidence of postoperative complications between ileostomy and colostomy procedures. Methods: Data analysis was conducted on 30 studies, and meta-analysis and trial sequential analysis (TSA) were performed on five studies. The basic indicators, such as stoma prolapse, leak, wound infection, ileus, and a series of other indicators, were compared. Results: No statistically significant differences were observed with complications other than stoma prolapse. Meta-analysis and TSA showed that the incidence of ileostomy prolapse was lower than that of colostomy prolapse, and the difference was statistically significant. Apart from the four complications listed above, the general data analysis showed differences in incidence between the two groups. The incidence of skin irritation, parastomal hernia, dehydration, pneumonia, and urinary tract infections was higher with ileostomy than with colostomy. In contrast, the incidence of parastomal fistula, stenosis, hemorrhage, and enterocutaneous fistula was higher with colostomy than with ileostomy. Conclusions: There were differences in the incidence of ileostomy and colostomy complications in the selected studies, with a low incidence of ileostomy prolapse. PROSPERO registration number: CRD42022303133. [ABSTRACT FROM AUTHOR]

Background: Despite advance in care of people with an ostomy, related complications remain prevalent. The objective of this study was to examine short- and long-term healthcare resource utilization and associated costs after ostomy creation. Methods: This observational study was based on retrospectively collected data from national and regional Swedish registries. The population consisted of people living in Sweden, who had an ostomy created. The earliest index date was 1 January 2006, and people were followed for ten years, until death, reversal of temporary ostomy, termination of purchases of ostomy products, or end of study, which was 31 December 2019. Each person with an ostomy was matched with two controls from the general population based on age, gender, and region. Results: In total, 40,988 persons were included: 19,645 with colostomy, 16,408 with ileostomy, and 4,935 with urostomy. The underlying diseases for colostomy and ileostomy creations were primarily bowel cancer, 50.0% and 55.8% respectively, and additionally inflammatory bowel disease for 20.6% of ileostomies. The underlying cause for urostomy creation was mainly bladder cancer (85.0%). In the first year after ostomy creation (excl. index admission), the total mean healthcare cost was 329,200 SEK per person with colostomy, 330,800 SEK for ileostomy, and 254,100 SEK for urostomy (100 SEK was equivalent to 9.58 EUR). Although the annual mean healthcare cost decreased over time, it remained significantly elevated compared to controls, even after 10 years, with hospitalization being the main cost driver. The artificial opening was responsible for 19.3–22.8% of 30-day readmissions after ostomy creation and for 19.7–21.4% of hospitalizations during the entire study period. For the ileostomy group, dehydration was responsible for 13.0% of 30-day readmissions and 4.5% of hospitalization during the study period. Conclusions: This study reported a high disease burden for persons with an ostomy. This had a substantial impact on the healthcare cost for at least ten years after ostomy creation. Working ability seemed to be negatively impacted, indicated by increased cost of sickness absence and early retirement. This calls for improved management and support of ostomy care for the benefit of the affected persons and for the cost of society. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate and compare sexual function in individuals with colorectal cancer, with and without a colostomy bag. A quantitative, descriptive-comparative design was employed, and a cluster random sampling method was used to recruit 252 patients with colorectal cancer. Data collection tools included a participants characteristics form, the International Index of Erectile Function (IIEF) for men, and the Female Sexual Function Index (FSFI) for women. The mean IIEF total score for men with a colostomy was 26.17 ± 15.30, and for men without a colostomy, it was 29.05 ± 17.14. The mean FSFI total score for women with a colostomy was 6.40 ± 7.21, and for women without a colostomy, it was 9.10 ± 14.67. There was no statistically difference in IIEF scores between men with and without colostomy bags (p > 0.05). However, women with colostomy bags had significantly lower FSFI scores compared to women without colostomy bags (p < 0.05). Addressing sexual concerns in individuals with colorectal cancer is crucial for enhancing their sexual well-being and overall quality of life. Comprehensive support, timely interventions, and targeted services are essential to help patients navigate the challenges and improve their overall well-being. [ABSTRACT FROM AUTHOR]

When patients who undergo ostomy surgery do not have access to an ostomy care nurse, staff nurses must assume responsibility for providing ostomy care and educational support. However, many staff nurses may lack the necessary knowledge and skills to provide this type of care. This article details the basics of pre- and postoperative care and patient education for nurses who encounter patients with two of the most common types of ostomy surgery of the bowel: colostomy and ileostomy. It covers the care of a new stoma and provides information about emptying and changing the pouch, nutritional and lifestyle considerations, and possible complications. The author details the basics of pre- and postoperative care and patient education for staff nurses who may encounter patients with two of the most common types of ostomy surgery: colostomy and ileostomy. [ABSTRACT FROM AUTHOR]

Aim: Even if a defunctioning stoma mitigates the serious consequences of anastomotic leakage after total mesorectal excision (TME) for rectal cancer, the presence of a temporary stoma or having a stoma for a prolonged period of time may also be a determining factor for further morbidities and poor bowel function. The aim of this study was to evaluate the impact of diverting stomas on clinical and functional outcomes after TME, comparing ileostomy or colostomy effects. Methods: All consecutive patients who underwent TME for rectal cancer between March 2017 and December 2020 in three Italian referral centres were enrolled in the present study. For every patient sex, age, stage of the tumour, neoadjuvant therapy, surgical technique, anastomotic technique, the presence of a diverting stoma, perioperative complications and functional postoperative status were recorded. Considering the diverting stoma, the kind of stoma, length of time before closure and stoma related complications were evaluated. Results: During the study period 416 consecutive patients (63% men) were included. Preoperative neoadjuvant therapy was performed in 79%. A minimally invasive approach was performed in >95% of patients. Temporary stoma was performed during the operation in 387 patients (93%) (ileostomy 71%, colostomy 21%). The stoma was closed in 84% of patients. The median time from surgery to stoma closure was 145 days. No difference was found between ileostomy and colostomy in overall morbidity after stoma creation and closure. Moreover, increased postoperative functional disturbance seemed to be significantly proportional to the attending time for closure for ileostomy. Conclusion: The presence of a defunctioning stoma seems to have a negative impact on functional bowel activity, especially for delayed closure for ileostomy. This should be considered when the kind of stoma (ileostomy vs. colostomy) is selected for each patient. [ABSTRACT FROM AUTHOR]

The incidence of obstetric anal sphincter injury in the UK is rising. This condition leads to significant morbidity in otherwise healthy women. Significant long-term complications of obstetric anal sphincter injury include anal incontinence, ano-vaginal or recto-vaginal fistula and psychological distress. Current management of third and fourth degree perineal tears post-vaginal birth is primary repair. This article discusses the role of a defunctioning colostomy in women with severe perineal tears in the immediate postnatal period. A defunctioning colostomy is a surgical procedure to open a section of colon (large bowel) onto the abdominal wall; a stoma bag is then worn over this to collect faeces. The rectum and anal canal are not used (defunctioned), while the stoma is in place and the perineum is healing. This article describes the purpose and operative steps of colostomy formation and reviews current published evidence of outcomes in those with colostomy formation for obstetric anal sphincter injury. It also addresses the difference in clinical approach between obstetricians and colorectal surgeons in relation to the management of severe obstetric anal sphincter injury and highlight the need for multidisciplinary input. [ABSTRACT FROM AUTHOR]

Background: People with ileostomy are frequently advised to avoid specific foods and food groups, making it plausible that they are at risk of a range of nutrition‐related adverse health consequences. Despite this there has been no recent study in the United Kingdom describing dietary intake, symptoms and food avoidance in people with ileostomy or post‐reversal. Methods: A cross‐sectional study was conducted at different time points in people with ileostomy and reversal. Participants were recruited at 6–10 weeks post‐formation (n = 17) and ≥12 months with established ileostomy (n = 16) and with reversal (n = 20). In all participants, ileostomy/bowel‐related symptoms in the previous week were assessed using a study‐specific questionnaire. Dietary intake was assessed using three online diet recalls or 3‐day dietary records. Food avoidance and reasons for food avoidance were assessed. Data were summarised using descriptive statistics. Results: Participants reported a few ileostomy/bowel‐related symptoms in the previous week. However, over 85% of participants reported avoiding foods, particularly fruits and vegetables. At 6–10 weeks the most common reason was being advised to do so (71%), although 53% avoided foods due to gas. At ≥12 months the most common reasons were foods visible in the bag (60%) or advised to do so (60%). Reported intakes of most nutrients were comparable to population medians, apart from lower fibre in people with ileostomy. Intakes of free sugars and saturated fats were above recommended levels in all groups, due to high consumption of cakes and biscuits and sugar‐sweetened drinks. Conclusion: After the initial healing period, foods should not be automatically excluded unless found to be problematic after reintroduction. There may be a need for healthy eating advice for people with established ileostomies and post‐reversal, targeting discretionary high‐fat, high‐sugar foods. Key points: People with ileostomy reported a few symptoms, but food avoidance was common, particularly of fruits and vegetables. The most common reason for avoiding a food was being advised to do so.Reported intakes of most nutrients were comparable to population medians, apart from fibre in people with ileostomy, mainly due to the low consumption of fruits and vegetables.People with ileostomy and ileostomy reversal reported high intakes of cakes, biscuits and sugar‐sweetened drinks, which resulted in diets high in saturated fat and free sugars. There may be an unmet need for dietary advice targeting high‐fat, high‐sugar discretionary foods in this population. [ABSTRACT FROM AUTHOR]

Pelvic actinomycosis with an intrauterine device accounts for approximately 3% of all actinomycoses. It is a chronic infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis, and caused by filamentous, gram-positive, anaerobic bacteria called Actinomyces israelii. The slow and silent progression favors pseudo tumor pelvic extension and exposes the patient to acute life-threatening complications, namely colonic occlusion with hydronephrosis. Preoperative diagnosis is often difficult due to the absence of specific symptomatology and pathognomonic radiological signs simulating pelvic cancer. We discuss the case of a 67-year-old woman who complained of pelvic pain, constipation, and weight loss for 4 months, and who presented to the emergency department with a picture of colonic obstruction and a biological inflammatory syndrome. The computed tomography scan revealed a suspicious heterogeneous pelvic mass infiltrating the uterus with an intrauterine device, the sigmoid with extensive upstream colonic distension, and right hydronephrosis. The patient underwent emergency surgery with segmental colonic resection and temporary colostomy, followed by antibiotic therapy. The favorable clinical and radiological evolution under prolonged antibiotic therapy with the almost total disappearance of the pelvic pseudo tumor infiltration confirms the diagnosis of pelvic actinomycosis and thus makes it possible to avoid an extensive and mutilating surgery with important morbidity. [ABSTRACT FROM AUTHOR]

Purpose: The optimal timing of stoma closure during or after adjuvant chemotherapy for rectal cancer patients undergoing sphincter-preserving surgery remains unknown. This study aimed to investigate the influence of clinical and oncological outcomes depending on the timing of stoma closure. Methods: Between January 2006 and December 2015, we enrolled 244 consecutive rectal cancer patients who underwent curative-intent sphincter-preserving surgery with diverting transverse colostomy and adjuvant chemotherapy. Patients with stoma closure during (During group) adjuvant chemotherapy were compared to those who had stoma closure after adjuvant chemotherapy (After group). Results: Parastomal hernia occurred more frequently in the after group than in the during group. (10% vs. 2.9%, p = 0.028). Overall, no significant difference was observed in overall survival (OS) or disease-free survival (DFS) between the two groups (p = 0.911 for OS, p = 0.505 for DFS). However, an inferior OS occurred if reopen surgery was performed within 30 days of stoma closure in the during group, as compared with the after group (p = 0.004). In addition, a marginally poor DFS was observed in the group of patients who received further operations due to 30-day stoma closure complications compared to the other patients (p = 0.07). Conclusions: For rectal cancer patients who underwent sphincter-preserving surgery, attention should be given to avoid 30-day major complications after stoma reversal because patients who require reoperation during adjuvant chemotherapy may have poor long-term survival. [ABSTRACT FROM AUTHOR]

Objective: Examine patients with locally advanced rectal cancer (LARC) with deficient mismatch repair (dMMR) or microsatellite instability-high (MSI-H) who received neoadjuvant immunotherapy (nIT), and compare the outcomes of those who chose a watch-and-wait (WW) approach after achieving clinical complete response (cCR) or near-cCR with those who underwent surgery and were confirmed as pathological complete response (pCR). Methods: LARC patients with dMMR/MSI-H who received nIT were retrospectively examined. The endpoints were 2-year overall survival (OS), 2-year disease-free survival (DFS), local recurrence (LR), and distant metastasis (DM). The efficacy of programmed cell death protein-1 (PD-1) inhibitor, immune-related adverse events (irAEs), surgery-related adverse events (srAEs), and enterostomy were also recorded. Results: Twenty patients who received a PD-1 inhibitor as initial nIT were examined. Eighteen patients (90%) achieved complete response (CR) after a median of 7 nIT cycles, including 11 with pCR after surgery (pCR group), and 7 chose a WW strategy after evaluation as cCR or near-cCR (WW group). Both groups had median follow-up times of 25.0 months. Neither group had a case of LR or DM, and the 2-year DFS and OS in each group was 100%. The two groups had similar incidences of irAEs (P=0.627). In the pCR group, however, 2 patients (18.2%) had permanent colostomy, 3 (27.3%) had temporary ileostomy, and 2 (18.2%) had srAEs. Conclusion: Neoadjuvant PD-1 blockade had high efficacy and led to a high rate of CR in LARC patients with dMMR/MSI-H. A WW strategy appears to be a safe and reliable option for these patients who achieve cCR or near-cCR after nIT. [ABSTRACT FROM AUTHOR]

Introduction: A colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Approximately 100,000 people in incidence in the United States undergo operations that result in a colostomy or ileostomy each year. Objective: To assess knowledge and associated factors toward colostomy care among staff Nurses working at Dessie Town governmental hospitals, Ethiopia 2022. Methods: Institutional-based cross-sectional study design was conducted at governmental hospitals in Dessie Town from August 1, 2022 to August 25, 2022. A simple random sampling technique was deployed using a self-administered questionnaire. Descriptive statistics analyses such as frequencies, percentage, and mean were used to summarize the results. Both bivariable and multivariable logistic regressions were employed to identify factors associated with participants' knowledge of colostomy care. A p -value of <.05 and 95% confidence interval (CI) was used to declare statistical significance. Results: A total of 265 nurses participated making a response rate of 98.1%. About 57.6% (157) of the participants had good knowledge of providing colostomy care. Having a clinical experience of 4–6 years (adjusted odds ratio [AOR] = 2.4 95% CI: 1.186, 5.513), 6–8 years (AOR = 2.5, 95% CI: 1.981, 6.177), and >8 years (AOR = 3.3, 95% CI: 1.481, 7.394), providing colostomy care for 6–10 patients (AOR = 2.6, 95% CI: 1.186, 5.512) and 10 or more patients (AOR = 3.3, 95% CI: 1.480, 7.394), and routine reading of professional (AOR = 1.83, 95% CI: 1.062, 3.153) were significantly associated with good knowledge of colostomy care. Conclusion and recommendation: Knowledge of colostomy care was not satisfactory among nurse professionals working in governmental hospitals in Dessie town. Participation in the training of colostomy care, having more than eight years of experience, providing colostomy care for more than seven patients, attending scientific colostomy meetings, and reading professional literature were significant factors associated with good knowledge of providing colostomy care. Thus, capacity-building in-service training is required to enhance the knowledge of colostomy care. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the perspectives of patients who had spinal cord injuries and were wheelchair-dependent on colostomy surgery, which is among the bowel movement methods. Methods: In this qualitative study, which was based on Heidegger's hermeneutical phenomenological approach, the Van Manen method was used to reveal how patients were affected by their experiences. The data of the study were collected by directly interviewing the patients and using a semi-structured interview guide. The interviews were recorded with a voice recorder device with the permission of the participants. Nine patients who were leading a life dependent on a wheelchair as a result of spinal cord injury made up the sample of the study. Results: Six of the participants were female. The ages of participants ranged between 32 and 52, and all of them were married. The results of the interviews indicated that the experiences of participants who were dependent on a wheelchair about bowel movement management consisted of three main themes: (a) difficult experiences; (b) coping with difficulties; and (c) colostomy awareness experience. Conclusions: Results showed that knowledge of a stoma obtained from different sources was a glimmer of hope for patients but that healthcare professionals did not exhibit a supportive attitude toward this hope. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is a major disease burden in low and middle-income countries like South Africa. Abdominal trauma is one of the leading reasons for emergency surgery. The standard of care for these patients is a laparotomy. In selected trauma patients, laparoscopy has both diagnostic and therapeutic usage. The trauma burden and the number of cases seen in a busy trauma unit make laparoscopy challenging. Aim: We wanted to describe our journey with laparoscopy in the management of abdominal trauma in a busy urban trauma unit in Johannesburg, South Africa. Methods: We reviewed all trauma patients who underwent diagnostic laparoscopy (DL) or therapeutic laparoscopy (TL) between 01 January 2017 and 31 October 2020 for blunt and penetrating abdominal trauma. The demographic data, indications for laparoscopy, injuries identified, procedures performed, intraoperative laparoscopic complications, conversion to laparotomy, morbidity, and mortality were evaluated. Results: A total of 54 patients who had laparoscopy were included in the study. The median age was 29 years (IQR 25–25). Most injuries were penetrating 85.2% (n = 46/54) and 14.8% blunt trauma. Most patients were males, 94.4% (n = 51/54). Indications for laparoscopy included diaphragm evaluation (40.7%), pneumoperitoneum for evaluation of potential bowel injury (16.7%), free fluid with no evidence of solid organ injury (12.9%) and colostomy (5.5%). There were 8 (14.8%) cases converted to laparotomy. There were no missed injuries or mortality in the study group. Conclusion: Laparoscopy in selected trauma patients is safe even in a busy trauma unit. It is associated with less morbidity and shortened hospital length of stay. [ABSTRACT FROM AUTHOR]

Total abdominal colectomy (TAC) with ileostomy is the standard treatment for severe ulcerative colitis (UC). Partial colectomy (PC) with colostomy may present a less morbid treatment option. The 2012-19 ACS-NSQIP database was queried to assess 30-day outcomes among patients undergoing TAC versus PC for UC, utilizing propensity score matching (PSM) techniques to account for differences in disease severity, patient selection, and presentation acuity. Before matching (n = 9888), patients undergoing PC were older, had more comorbidities, and experienced higher complication and 30-day mortality rates (P < 0.001). After matching (n = 1846), patients undergoing TAC experienced higher 30-day overall complications (41.9% versus 36.5%, P = 0.017) and serious complications (37.2% versus 31.5%, P = 0.011). Sensitivity analyses of older patients and those undergoing nonemergency surgery demonstrated higher overall rates of complications for patients receiving TAC. However, among patients undergoing emergency surgery only, no differences in complications were seen between the two surgical approaches. PC with colostomy in the setting of ulcerative colitis has similar 30-day outcomes to TAC with ileostomy. PC may be an acceptable surgical alternative to TAC in select patients. Studies investigating longer-term outcomes are necessary to further investigate this option. • Total abdominal colectomy is the standard treatment for severe ulcerative colitis. • Partial colectomy may be an alternative option. • Thirty-day complication rates were higher in TAC patients after propensity-score matching. • Outcomes were equivalent between operative approaches in emergency cases. [ABSTRACT FROM AUTHOR]

Aim: Enhanced recovery after surgery (ERAS) are multimodal perioperative pathways that have shown improved outcomes. ERAS after colostomy reversal has shown promising results in adults and few pediatric studies. We report our experience using ERAS for a colostomy reversal. Materials and Methods: A retrospective analysis of children in whom ERAS was used during colostomy reversal between May 2016 and 2019 was carried out. ERAS protocol in our study included avoiding mechanical bowel preparation (MBP), oral liquid diet up to 3 h preoperatively, usage of regional anesthesia, minimal handling of bowel intraoperatively, using nonopioid analgesics for pain relief, early initiation of feeding on the first postoperative day, early discharge once full feeds are established. Outcomes analyzed are the duration of hospital stay and complications, including readmissions. Requirement for opioids and anti-emetics are noted. The outcomes are compared with traditional care pathways (TCP), which use MBP, overnight fasting, opioid analgesia, and delayed feeding. A total of 48 are included in the study, with 13 cases using ERAS and TCP in 35 cases. Statistical Analysis Used: Nonparametric Mann-Whitney U-test was used. Results: In the ERAS group, the mean length of hospital stay (LOS) postoperatively was 3.7 days (2-5 days) as opposed to 7.2 days (5-11 days) in TCP. There was only one child with complications in the ERAS group, while 9 cases in TCP had complications, though none of them required operative intervention. There was the requirement of anti-emetic in only one child in the ERAS group. Conclusion: ERAS for colostomy reversal is feasible in the pediatric population. For successful implementation, all personnel involved in the care of the child need to be educated about the protocol. It reduces LOS and complications. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Temporal percutaneous transhepatic duodenum drainage (PTDD) seems to be effective in the treatment of postoperative afferent loop syndrome (ALS) following transverse loop colostomy for obstructive colorectal cancer. Management of obstructive colorectal cancer still remains a challenge. There are various options with different risks of mortality and mobility for obstructive colorectal cancer. A rare unexpected postoperative ALS following a low anterior resection and transverse loop colostomy for obstructive colorectal cancer is presented in this report. A 64‐year‐old man had the acute ALS had been noted 10 days after transverse loop colostomy. An option was temporal PTDD treatment in the patient with history of Billroth's operation II for upper gastrointestinal bleeding 30 years ago. Acute ALS was treated by temporal PTDD. The drainage tube for PTDD was not removed until closure of the transverse colostomy 2 months later. The patient recovered uneventfully. Acute ALS after transverse loop colostomy for obstructive colorectal cancer is rare and has never been reported in the literature. The mechanism of acute ALS after construction of a loop colostomy and the treatment strategy of PTDD for acute ALS is presented. [ABSTRACT FROM AUTHOR]

Background: There are several emergency surgical methods for completely obstructed colorectal cancer, such as colostomy, tumor resection with Hartmann's procedure, or primary anastomosis with on-table lavage, sometimes adding protective ostomy. This treatment depends on the patient's condition and the surgeon's experience. As a result, patients need to undergo more than one operation. Therefore, if the effects of emergency surgery combined with manual fecal decompression and primary anastomosis are as effective as elective surgery, it will reduce patient complications. Objective: To compare the short-term outcomes after primary anastomosis between an emergency operation with manual fecal decompression in completely obstructed left-sided colorectal cancer and non-obstructed colorectal cancer in elective bowel preparation. Methods: A retrospective study comparing the short-term outcomes after primary anastomosis in completely obstructed left-sided colorectal cancer between an emergency operation with manual fecal decompression and elective bowel preparation in non-obstructed left-sided colorectal cancer in Buriram Hospital from 2009-2023. Short-term outcomes were analyzed, including anastomotic leak, surgical site infection, hospital stay, Dindo-Clavien classification, readmission, and mortality within 30 days after the operation. Given a statistically significant difference of p-value < 0.05. Results: There were 105 left-sided colorectal cancer patients, 52 men and 53 women. Emergency surgery, manual fecal decompression, and primary anastomosis 49 cases (46.7%), and elective surgery 56 cases (53.3%). There was no statistically significant in postoperative complication, Dindo-Clavien classification, and mortality in 30 days (p-value > 0.05). None of the patients had to be re-hospitalized within 30 days. Risk factors for complications were age ≥ 60 and preoperative comorbidity. Conclusion: Emergency surgery for completely obstructed left-sided colorectal cancer with manual fecal decompression and primary anastomosis is as effective as the short-term outcomes in elective bowel preparation surgery for non-obstructed left-sided colorectal cancer. [ABSTRACT FROM AUTHOR]

This is a retrospective study of 264 intestinal stomas performed in the surgical unit of the Emergency Clinical Hospital "Bagdasar Arseni", Bucharest, within a 7-year period (2015-2021) aiming to evaluate their evolutive complications, risk factors, management and prevention strategies. Material and method. Colostomies: 218 (82.57%) cases, ileostomies 46 (17.43%) cases. Temporary stomas (103 cases or 39.02%) were isolated stomas of discharge in 45 cases and associated with other colorectal procedures in 58 cases. Postoperative complications included general systemic complications in 60 (22.72%) cases and local complications specific to stomas in 84 (31.81%) cases and common to abdominal surgery in 94 (35.60%) cases, which were solved by reoperation in 51 cases, with a reintervention rate of 19.31%. Stoma closures were performed in 34 (33.0%) of the 103 patients with temporary stomas. Of these, 26 (25.24%) patients died in the early postoperative period (< 30 days), the remaining 60 patients refused reintervention or were lost to follow-up. Conclusions. Faecal diversion still represents a therapeutic option for a wide range of benign or malignant digestive or extra-digestive abdominal diseases performed in emergency or scheduled surgeries, mostly for colorectal cancer and its complications. [ABSTRACT FROM AUTHOR]

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Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m², altered collagen metabolism, and diabetes. [ABSTRACT FROM AUTHOR]

Background: The present study is designed to deal with an indication of various stoma surgery, type of stoma formed, and various ju=of General surgery, RG Kar Medical College and hospital, Kolkata, from June 2020 to May 2021 The study includes patients 12 years and

Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

Prolonged foreign body impaction resulting in a rectovaginal fistula is one of the rare case scenarios presenting nowadays due to increased awareness and widespread availability of health care centers. Also, the taboo of reporting to healthcare personnel for rare gynecological problems is also decreasing. This patient reported with a foreign body in the form of a hair clutcher inserted in her vagina 3 years back by her boyfriend. She presented with complaints of itching, foreign body sensation in the vagina, and pain abdomen in the supra pubic area for 3 months after she got married. The diagnosis was confirmed on per rectal and per vaginal examination followed by contrast-enhanced computed tomography pelvis. Intraoperatively, the foreign body was found to be impacted in both rectum and vagina, resulting in a rectovaginal fistula. The fistula was repaired and a diversion colostomy was done. After 12 weeks, colostomy closure was done, and the patient was discharged with no postoperative complications.

Metachronous carcinoma at the colostomy site is very rare after abdominoperineal resection. A 53-year-old male patient underwent an abdominoperineal resection 6 years earlier for rectal cancer developed metachronous carcinoma at the site of stoma. A portion of the colon, including the stoma and the surrounding skin, was resected and a new stoma was created in the transverse colon. Although the occurrence of carcinoma at the stoma site is a rare condition, careful observation for the stoma and colonoscopy for surveillance are necessary.