Blowhole colostomy for the urgent management of distal large bowel obstruction

Abstract Background Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction. Methods Retrospective chart revi...

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Bibliographic Details
Published in:The Journal of surgical research 2014-05, Vol.188 (1), p.53-57
Main Authors: Kasten, Kevin R., MD, Midura, Emily F., MD, Davis, Bradley R., MD, Rafferty, Janice F., MD, Paquette, Ian M., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Blowhole
Cancer
Colonic Diseases - etiology
Colonic Diseases - surgery
Colostomy
Colostomy - methods
Emergency Medical Services
Female
Humans
Intestinal Obstruction - etiology
Intestinal Obstruction - surgery
Length of Stay
Male
Middle Aged
Obstruction
Operative Time
Retrospective Studies
Stricture
Surgery
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Summary:Abstract Background Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction. Methods Retrospective chart review of all colostomy procedures (CPT 44320) performed for complete distal large bowel obstruction during the past 6 y in a university hospital practice was undertaken. Blowhole was compared with loop colostomy with a primary endpoint of successful colonic decompression. Results One hundred forty-one patients underwent colostomy creation during the study period. Of these, 61 were completed for acute obstruction of the distal colon or rectum (19 blowhole versus 42 loop colostomy). No differences between study groups were seen in age, gender, body mass index, malnutrition, American Society of Anesthesiology class, time to liquid or regular diet, 30-d or inhospital mortality, or rates of complications. Patients undergoing blowhole colostomy had significantly higher cecal diameters at diagnosis (9.14 versus 7.31 cm, P  = 0.0035). Operative time was shorter in blowhole procedures (43 versus 51 min, P  = 0.017). Postoperative length of stay was significantly shorter for blowhole colostomy (6 versus 8 d, P  = 0.014). The primary endpoint of successful colonic decompression was met in all colostomy patients. Conclusions Diverting blowhole colostomy is a safe, quick, and effective procedure for the urgent management of distal colonic obstruction associated with obstipation and massive distention.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2014.01.007