PubMed · 3168674
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N N Gill-Thompson. 1988. Colostomy irrigations.. https://doi.org/10.1007/bf02560123
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PURPOSE: We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. METHOD: A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. CONCLUSION: Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.
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The assessment of capability of work consist of measuring the patient subjective willingness to perform and his efficiency which should be objectively examined by functional diagnostic tools. On the one hand, there is the consideration of the patients psycho-mental burdens and on the other hand has to be defined the extent of organic functional restrictions. The latter is difficult to assess because diseased organs of the gastrointestinal tract are not directly involved in the efficiency of work. In chronic diarrhea purely watery diarrhea causes mobility restrictions at the place of work. In case of chronic malabsortive diarrhea, psycho-mental and physical deficits of efficiency have to be taken into account. The latter however may be almost restored by adequate substitution of macro and micro nutrients. For the clinical assessment of the severity of incontinence and ist psychosocial effects structured history sheets and working up of clinical findings and specifics function tests are necessary. The so defined degree of stool incontinence determines the restrictions of vocational efficiency. Generally persons with stoma are nearly not disabled and capable of gainful employment. This also pertains to professions with specific hygienic requirements, such as a production and distribution of foods. Persons with well applied and provided stomata should avoid severe physical burdens, unsuitable postures and periodical forms of labour like piece-work.