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Category: Volume 05 Issue 11 November 2017
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Title: Ostomy in Acute Abdominal Conditions: A Study of 30 Cases

Authors: Dr Arvind Kumar Prabhat, Dr Niranjan Dash, Dr J.M. Gadekar, Dr Mrs. V.J.Thipse

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.122

Abstract

Background: Ostomy is an approved surgical option for management of bowel dysfunction and anatomical bowel anomalies, which may results in peritonitis and sepsis, leading to multi-organ failure.

Aim and Objective: To study the feasibility and outcome of ostomy in cases of acute abdomen.

Materials and Methods: We prospectively analyzed 30 cases of acute abdomen, undergoing intestinal stoma formation, following emergency laparotomies in the department of surgery, DVVPF’S Medical College and Hospital, Ahmednagar, Maharashtra during the study period of January 1, 2014 to March 1, 2017. The clinical diagnosis was supported by X-ray erect abdomen, ultrasonography and Contast-enhanced computed tomography.

Results: The study comprised of 30 patients with the mean age of 58 years, with 26 males and 4 females patients. Out of thirty patients of ostomy recruited for the study, 18(60%) and 12(40%) patients underwent colostomies and ileostomies respectively. Colostomy was performed on 18 patients out of which 4(13%) patients suffered from sigmoid volvulus, 2(7%) patients from rectal perforation, 2(7%) patients from carcinoma rectum, 2(7%) patients with rectosigmoid tumor secondary to ovarian carcinoma, 1(3%) patient with intestinal adhesion, 2(7%) patients with splenic flexure neoplastic mass, and 5(16%) patients with cancer sigmoid colon. Temporary Colostomy was performed in 14(78%) patients and Permanent colostomy in 4(22%) patients. Among colostomy patients, 2(11%) patients died. Cause of death was multiorgan failure. Low Anterior Resection (LAR) with ileostomy was performed in 12(40%) cases of carcinoma rectum. 2(8%) patients of ileostomy had died due to anastomotic leakage.

Conclusion: Ostomy is a salvage procedure in saving life of the acute abdomen patients in an emergency setting. This is the preferred surgical option especially for palliation before neoadjuvant chemotherapy and in high risk patients that are not fit for emergency definitive surgery. Protective stoma effectively decreases the incidence of anastomotic leak, post-operative ileus, wound infection, small bowel obstruction, morbidity, mortality and recurrence in cases of bowel pathology.

Keywords: Carcinoma rectum; Colostomy; Ileostomy; Peritonitis; Sepsis.

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Corresponding Author

Dr Arvind Kumar Prabhat

Postgraduate Student, Department of General Surgery,

DVVPF’s Medical College and Hospital, Ahmednagar, Maharashtra, India