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At least 19 recordsLinked to original sources
PubMed1987

Enterostomy in necrotizing enterocolitis: an analysis of techniques and timing of closure.

Resection and enterostomy are the standard operative procedures for necrotizing enterocolitis (NEC). In order to compare the results of two different methods of enterostomy, a study was carried out in 100 infants with NEC who underwent enterostomy formation and closure. A single surgeon at each of the two collaborating institutions conducted the majority of operations. Level of enterostomy was jejunum in 10, ileum in 75, and colon in 15. Type of enterostomy was separate stomas (usually brought out side by side) in 50, Mikulicz enterostomy in 39, single stoma with Hartmann's pouch in 10, and loop colostomy in 1. Complications of enterostomy formation occurred in 24 infants (24%). When infants with separate stomas were compared with those with the Mikulicz enterostomy, there was no difference in the rate of stomal or wound complications. The separate stomas had a higher rate of stricture formation in the distal bowel (36% v 18%), which may be accounted for by earlier reestablishment of intestinal continuity in the Mikulicz group. Both methods exteriorized the bowel ends close to one another, which was advantageous because subsequent closure was usually performed without a formal laparotomy. After enterostomy closure, 17 (17%) infants had complications. There was no difference in complication rate between early (before 3 months or under 2.5 kg) v late closure, or between closure of the Mikulicz enterostomy v separate stomas (although the Mikulicz enterostomy closure was accomplished more rapidly than closure of separate stomas). Morbidity was unrelated to level of enterostomy, type of enterostomy, maturing the stoma, bringing it through a separate incision, or age or weight of the infant at closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Colostomy↗
PubMed1998

High morbidity of enterostomy and its closure in premature infants with necrotizing enterocolitis.

OBJECTIVE: To review the morbidity and mortality among 68 premature infants treated with enterostomy for necrotizing enterocolitis. DESIGN: Data were collected retrospectively from hospital medical records to include the period between January 1, 1987, and September 30, 1997. SETTING: Tertiary care children's hospital. PATIENTS: A group of 68 infants aged 2 to 35 days (mean age, 12.5 days), weighing 1500 g or less, with necrotizing enterocolitis necessitating surgical enterostomy for treatment. INTERVENTIONS: Creation of any enterostomy during exploratory laparotomy for necrotizing enterocolitis and subsequent closure. MAIN OUTCOME MEASURES: Morbidity and mortality associated with infant enterostomy and its closure. RESULTS: Thirty-nine infants underwent ileostomy with mucous fistula, 16 underwent ileostomy with a Hartmann pouch, 7 had jejunostomy with mucous fistula, 2 had colostomy with mucous fistula, and 4 had colostomy with a Hartmann pouch. Eighteen (26%) of the 68 infants died in the postoperative period of sepsis (n = 10), continuing necrotizing enterocolitis (n = 5), or respiratory distress (n = 3). Of the remaining 50 infants, complications developed in 34 (68%). These complications included strictures requiring further resection at the time of enterostomy closure in 20 infants; stricture of the enterostomy requiring surgical revision in 6; incisional hernia in 3; parastomal hernia in 4; enterostomal prolapse or intussusception in 6 and 1, respectively; wound dehiscence in 4; wound infection in 8; small-bowel obstruction requiring laparotomy in 2; and anastomotic complications in 2. Only 16 enterostomies were closed uneventfully, with 3 of these infants subsequently dying of sudden infant death syndrome between 6 and 8 months after the operation. Of the surviving infants, 3 (6%) continue to require home hyperalimentation. CONCLUSIONS: Although enterostomy in infants with low birth weight with necrotizing enterocolitis may be lifesaving, it is also a major cause of morbidity. These data suggest the feasibility of a prospective study comparing resection and primary anastomosis with resection and enterostomy.

Enterocolitis, Pseudomembranous↗
PubMed1995

Enterostomy and its closure in newborns.

OBJECTIVES: To examine the morbidity and mortality in 109 newborns who required enterostomy for intestinal necrosis, perforation, or obstruction and to analyze the complications associated with enterostomy closure. DESIGN: Data were collected retrospectively from hospital and office charts. Follow-up was 1 to 6 years. SETTING: Tertiary care, newborn intensive care unit at a children's hospital. PATIENTS: A referred sample of 109 newborns (aged 0 to 28 days) with bowel necrosis, obstruction, or perforation, who underwent enterostomy as part of their therapy. INTERVENTIONS: Operative formation of any enterostomy during laparotomy for bowel necrosis, obstruction, or perforation and subsequent closure. MAIN OUTCOME MEASURES: Morbidity and mortality associated with newborn enterostomy and its closure. RESULTS: Patients underwent jejunostomy (n = 31), ileostomy (n = 62), or colostomy (n = 16) for necrotizing enterocolitis (n = 79), atresia (n = 15), idiopathic perforation (n = 8), volvulus (n = 4), or meconium ileus (n = 3). Seventeen (16%) died postoperatively of sepsis, respiratory distress, further necrotizing enterocolitis, or intraventricular hemorrhage. Complications developed in 10 (34%) of the remaining 29 patients who underwent jejunostomy, whereas in 13 (26%) of 50 patients who underwent ileostomy and three (23%) of 13 patients who underwent colostomy, complications requiring revision developed. Ninety-two patients underwent enterostomy closure 14 to 65 days after enterostomy. Four later died of continuing respiratory distress and liver failure. Fifteen (56%) of 27 jejunostomies, 28 (57%) of 49 ileostomies, and nine (75%) of 12 colostomies were closed uneventfully, whereas two jejunostomy and eight ileostomy closures dehisced, requiring repeated enterostomy and secondary closure. All 10 children with anastomotic dehiscence had necrotizing enterocolitis originally, showed poor weight gain (< 30% per month), and had low serum albumin levels (22 +/- 3 g/L) compared with children with successful primary closure (> 30% weight gain per month; serum albumin level, 37 +/- 6 g/L; both Ps < .05). CONCLUSION: These data show that enterostomy is a potentially morbid condition in the newborn and is prone to complications but should be closed only when the child is in satisfactory nutritional condition.

Enterostomy↗
PubMed1988

Pre-surgery information and psychological adjustment to enterostomy.

The post-surgery psychological adjustment to enterostomy was examined in a longitudinal study of 120 patients. Subjects were representative of the general enterostomy patients population. All had undergone surgery in various hospitals located in Rome and its surroundings. Adjustment to enterostomy was longitudinally evaluated by interviewing patients at various intervals after enterostomy: soon after surgery; 1 year after surgery; more than 1 year after surgery. When patients were initially interviewed, information was requested on how they were informed of their clinical condition which led to surgery, as well as of enterostomy and its consequences. 42% reported a low level of understanding about enterostomy on the basis of information received during hospitalization. Patients were consequently divided into two groups, one including those judged as adequately informed (AI), and the other including those judged as not adequately informed (NAI). These groups were compared, for immediate adjustment to enterostomy (within 3-6 mos. since surgery), delayed adjustment (1 yr. since surgery), and prolonged adjustment (more than 1 yr. since surgery). Patients of NAI group demonstrated a consistently poorer pattern of adjustment in all parameters under study (emotional, cognitive, behavioral, social) and their adjustment to enterostomy did not show any spontaneous improvement over the time. AI patients, on the other hand, showed a more favorable level of adjustment since after surgery and a more positive pattern in the follow-up period. Adequate information before surgery and during hospitalization has been evidenced as a necessary component of patient care and a very important element in determining the optimal functional and psychological recovery of patients with enterostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed2001

Enterostomy complications in infancy and childhood.

BACKGROUND: A number of severe gastrointestinal disorders in infancy and childhood may require the formation of an enterostomy as a crucial part of the treatment of the disease itself. This study reviews our pediatric patients with regard to the morbidity and mortality of enterostomy formation and closure over an 8-year period. PATIENTS AND METHODS: Sixty-eight enterostomies in infants and children and 60 consecutive enterostomy closures in retrospect are reported on. This includes colostomies, jejunostomies, ileostomies, and Mikulicz procedures. RESULTS: In most instances, a transverse colostomy was performed. The most frequent indications were intestinal obstruction and necrotizing enterocolitis. More than half of the children were less than 1 month of age at the time of surgery. We observed an overall complication rate of 38.2% following enterostomy formation, with stoma prolapse being the most common, but faced major complications (such as sepsis, peritonitis, and enterocutaneous fistula) in only 10.3%. Complications after enterostomy closure were encountered in 20%. The overall mortality was 7%. CONCLUSION: Enterostomy formation and closure in the pediatric age group with severe underlying disease is still associated with substantial morbidity.

Adolescent↗
PubMed2004

The Santulli enterostomy in necrotising enterocolitis.

An ideal operation for necrotising enterocolitis (NEC) would be quick and reliable, remove all nonviable bowel, minimise the loss of intestinal length, permit early restoration of intestinal continuity, and minimise the need for secondary operations. No operation currently meets all these needs. In this study we review our experience with the Santulli enterostomy in NEC. From 1992 to 1998, 19 patients (16 males, three females) underwent a Santulli enterostomy for Bell grade III NEC. The median gestational age at birth (GA) was 26 weeks (range 23-30), and the median birth weight 755 g (range 600-1095). The median patient age at operation was 10 days (range 3-59), and the median operative time was 55 min (range 25-90). Sixteen (84%) patients survived. Complications included leakage of the Santulli anastomosis in four cases, stomal necrosis in two cases, additional intestinal necrosis in two cases, leakage of a concurrent intra-abdominal anastomosis in two cases, and intestinal obstruction in four cases. Twelve patients underwent relaparotomy. Enteral feeding was started at a median of 5 days postoperatively (range 2-9), with full oral feeding possible at a median of 21 days (range 10-128). The median time until closure of the enterostomy was 48 days and the median hospital stay 87 days (range 19-197). After stomal closure, obstructive symptoms necessitated a new Santulli enterostomy in two patients and a revision of the anastomosis in one patient. Santulli enterostomy can be used to treat NEC even in very small premature babies. It enables rapid recovery of intestinal continuity and early stomal closure. However, the operation is technically demanding and carries significant morbidity.

Anastomosis, Surgical↗
PubMed2004

Mucous fistula refeeding in premature neonates with enterostomies.

BACKGROUND: Premature neonates with short bowel syndrome often have diverting enterostomies and distal mucous fistulae. The authors reviewed their experience in 12 premature neonates in whom proximal bowel contents were re-fed into the mucous fistula. METHODS: We reviewed the records of 12 premature neonates who presented with acute abdomen and who underwent intestinal resection with formation of diverting enterostomy and mucous fistula between July 1999 and December 2002. All received parenteral nutrition. Refeeding of enterostomy contents into the distal mucous fistula was commenced after patency of the distal intestine was confirmed by radiologic examination. Demographic data, body weight and clinical outcomes were recorded. RESULTS: Median gestational age was 31 weeks and mean birth weight was 1.59 kg. Diagnoses included necrotizing enterocolitis (n = 6), meconium ileus-like conditions (n = 2), ileal atresia (n = 2), malrotation with volvulus (n = 1) and focal intestinal perforation (n = 1). Refeeding was successfully established in all patients with no complications. The mean duration of refeeding was 63.5 days. All patients achieved good weight gain after refeeding (18.9 +/- 2.9 g/d) with a reduction of parenteral nutrition requirements. All enterostomies were subsequently closed. Four patients died of unrelated causes after reanastomosis and the remaining eight were discharged. CONCLUSIONS: Mucous fistula refeeding is safe in premature neonates with enterostomies. It can prevent disuse atrophy in the distal loop and facilitate subsequent reanastomosis. Furthermore, the increased absorptive function provided by the small bowel incorporated in the mucous fistula can reduce the requirement for total parenteral nutrition.

Enterostomy↗
PubMed2002

Laparoscopic-assisted enterostomy tube placement and full-thickness biopsy of the jejunum with serosal patching in dogs.

OBJECTIVE: To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. ANIMALS: 15 healthy dogs. PROCEDURE Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. RESULTS: The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.

Animals↗
PubMed1989

Prevention of hernia after enterostomy.

Enterostomies are usually well tolerated if they function optimally. A common problem is a hernia at the enterostomy site. Separation of the lateral aspect of the enterostomy tunnel from the seromuscular layer of the intestine permits a space to occur. With time, intra-abdominal pressure gradually enlarges this space to bring about the hernia. To prevent a hernia from developing after an enterostomy, a new principle of enterostomy construction is demonstrated. After proper positioning of the intestine within the tunnel, it is returned to the abdomen to allow accurate placement of sutures. These sutures bring together the lateral aspect of the tunnel and the remote side of the intestine. If no space is allowed, no hernia will occur.

Enterostomy↗
PubMed2002

Palliative percutaneous tube enterostomy in afferent-loop syndrome presenting as jaundice: clinical effectiveness.

The purpose of this study was to investigate the clinical effectiveness of percutaneous tube enterostomy in afferent loop syndrome presenting as jaundice. Tube enterostomy was successfully performed in seven patients without procedural complications. The serum bilirubin level normalized in five patients but remained elevated in the other two, presumably related to more proximal bile duct obstruction. Percutaneous tube enterostomy is an effective palliative treatment in afferent loop syndrome presenting as an obstructing jaundice. However, coexisting biliary obstruction might be problematic for relieving jaundice with tube enterostomy.

Adult↗
PubMed1999

Conservative intestinal surgery to avoid short-bowel syndrome in multiple intestinal atresias and necrotizing enterocolitis: 6 cases treated by multiple anastomoses and Santulli-type enterostomy.

Neonates with multiple sites of intestinal atresia (MIA) may be predisposed to short-gut syndrome. Anastomoses of the intervening segments may prevent this complication. 5 neonates with MIA, one of them with a gastroschisis, were operated on: a proximal enterostomy was constructed, a side-to-end anastomosis as described by Santulli and several end-to-end anastomoses between the intervening intestinal segments (n = 3 to 7) were performed. An additional infant, initially operated on for a necrotizing enterocolitis (NEC) was managed with the same surgical procedure. Without use of this technique, the remaining length of small intestine would have been 28, 27, 40, 58, 70 and 7 cm. This technique enabled an intestinal length of 49, 54, 96, 107, 92 and 93 cm respectively to be achieved. Ileocecal valve was present in all 5 cases with MIA, but resected in the case with NEC. The enterostomy was reversed 7 weeks later. The initial outcome (delay of enteral feeding, duration of parenteral nutrition) was good: the babies were weaned from parenteral nutrition (PN) after a mean time of 90 days (48 to 163 days). The prognosis (mean follow-up: 31 months, range 14 to 57) was good with regards to growth and development and length of time required before adaptation to normal enteral feedings and stools. This surgical method allows complete decompression of the proximal jejunum so that nutriment can pass into the distal bowel allowing it to enlarge. In cases of MIA, a long tapering proximal enteroplasty is a better procedure than resecting more than 5-10 cm of the proximal distended and hypertrophied bowel. We prefer to perform an enterostomy in association with multiple anastomoses between intervening intestinal segments. The enterostomy is preserved for long enough waiting period to enable the reversion of the histochemical and morphological changes that may have taken place in the bowel.

Anastomosis, Surgical↗
PubMedDate not supplied

[Enterostomy post emergency enterectomy].

This is a clinical approach regarding 43 resection of intestine, performed in emergency condition, terminated as enterostomy, with represent 20% of enterectomyes performed in emergency condition and 1.6% of urgent operations. The decision of enterostomy has been taken in the conditions of peritoneal sepsis, occlusion or the association of the two circumstances. The results are comparatively analyzed between the cases with enterostomy that has been made from the beginning (66% success, 33% gone wrong), and those with enterostomy made at the second intervention (14% success, 86% gone wrong). One discusses problems of leading, technique and post-operating nursing. The intestinal reintegration has been made possible at 16 patients after a timing of three of four weeks.

Adolescent↗