CC BY 4.0 · Journal of Coloproctology 2024; 44(S 01): S1-S138
DOI: 10.1055/s-0045-1808834
Temas Gerais Dentro da Especialidade
General Topics Within the Specialty
ID – 138287
E-poster

CASE REPORT: TREATMENT OF COLOSTOMY STENOSIS IN A CRITICAL PATIENT THROUGH EXCORPOREAL STAPLING

Rodrigo de Almeida Paiva
1   Hospital Felício Rocho, Belo Horizonte, Brasil
,
Daniel Maurício Londoño Estrada
1   Hospital Felício Rocho, Belo Horizonte, Brasil
,
Letícia Brandão Castro
1   Hospital Felício Rocho, Belo Horizonte, Brasil
,
Artur Duarte e Duarte
1   Hospital Felício Rocho, Belo Horizonte, Brasil
,
Marina Barbabela Grisolia de Oliveira
1   Hospital Felício Rocho, Belo Horizonte, Brasil
,
Lucas Alves Bessa Cardoso
1   Hospital Felício Rocho, Belo Horizonte, Brasil
,
Eduardo Carvalho Barbosa
1   Hospital Felício Rocho, Belo Horizonte, Brasil
› Author Affiliations
 

    Case Presentation A male patient, 83 years old, with a history of hypertension, diabetes mellitus, coronary artery disease, mild cognitive decline, and partial dependency, underwent a retossigmoidectomy and primary anastomosis due to colon adenocarcinoma. On the 5th postoperative day (DPO), he developed an anastomotic leak and was referred for another surgical approach, resulting in a Hartmann colostomy. He had a prolonged hospitalization with slow recovery and mobility restriction. After returning home, he developed abdominal pain and loss of appetite. During outpatient follow-up, an anastomotic stenosis was detected. Attempts at dilation were made, but without a definitive resolution. During this period, the patient developed deep vein thrombosis (DVT) in the lower limbs, requiring therapeutic anticoagulation, followed by a severe case of dengue, requiring intensive care for management of electrolyte disturbances and acute renal failure. In this context, the patient experienced worsening pain and an obstructive condition due to retraction and near-complete stenosis of the ostomy, along with skin healing over the stoma. Given the worsening overall clinical condition, a local approach to the ostomy was chosen, and extracorporeal stapling was proposed and performed. A skin incision was made to expose the colonic mucosa, a colostomy bag was placed in the terminal colostomy, and adjacent tissues (mucosa and skin) were approximated. Stapling was done with a 28 mm circular stapler, re-fixing the ostomy at the same site. Post-procedure, gas release was observed on the 1st DPO, with proper function up to 60 days.

    Discussion Colostomy creation is a common procedure in colorectal surgeries, and stenosis occurs in up to 15% of postoperative complications, causing significant discomfort to patients and often requiring re-surgical intervention. Periodic dilation is commonly used but often worsens the condition. Thus, when there is no plan for reconstructive surgery, especially in more severe clinical contexts, local ostomy revision seems to be a viable alternative.

    Conclusion Extracorporeal stapling proved to be a good alternative for treating colostomy stenosis in a patient with increased surgical risk and no planned reconstructive surgery.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    25 April 2025

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