Authors
Levchuk A.L.1, Abdullaev A.E.2
1 Pirogov National Medical and Surgical Center, Moscow
2 GKB SMP, Vladimir
Abstract
The aim of the study was to evaluate the diagnostic capabilities and treatment outcomes of patients with early and late paracolostomy complications after obstructive colon resection for the complicated course of DBTC. Systematization of technical errors that are most often made during surgical intervention during the imposition of terminal colostomae. Optimization of surgical correction methods and management of patients with complicated colostomy.
Materials and methods. A single-center, randomized, retrospective study was conducted with the participation of 50 patients with paracolostomy complications who were treated at the Vladimir State Clinical Hospital after obstructive colon resections for DBTC from 2019-2024. There were 31 (62%) men and 19 (38%) women. The average age of the patients was 56.2±11.3 years. In 24 (48%) (group I) cases, there was a clinical picture of peritonitis. At admission, 26 (52%) (group II) patients had a clinical picture of acute diverticulitis, but without peritonitis. Surgical interventions were performed in 100% of cases.
Results. In 8 (16%) cases, free gas was detected on an abdominal X-ray. All 24 patients with a peritonitis clinic and a rengenological picture of hollow organ perforation underwent emergency surgery in the form of laparotomy, Hartmann surgery with resection of a section of the colon with diverticular perforation. In the group of patients (n-26) who underwent surgery on a delayed basis, after anti-inflammatory and antimicrobial therapy, in 13 (26%) cases, ultrasound revealed acute diverticulitis of the sigmoid colon with the formation of a paracollar infiltrate and with local accumulation of fluid. Necrosis of the colostomy occurred in 9 (18%) patients. Colostomy retraction was registered in 8 (16%) cases. Colostomy bleeding occurred in 4 (8%) cases. A parastomal abscess occurred in 4 (8%) patients. Paracolostomy phlegmon was registered in 3 (6%) cases. Paracolostomy dermatitis was registered in 8 (16%) cases. A paracolostomy hernia was registered in 6 (12%) cases. Colostomy stricture occurred in 7 (14%) patients. Colostomy malignancy occurred in 3 (6%) patients.
Conclusion. Colostomy is one of the most common colon surgeries performed under special conditions and is life–saving in desperate situations. The improvement of the colostomy technique, the choice of the level and location of its formation, as well as preoperative marking on the anterior abdominal wall, are factors that reduce the number of paracolostomy complications in patients with perforated diverticulitis of the colon.
Keywords: diverticular disease of the colon, colostomy complications, perforation of the diverticulum of the colon, paracolostomy complications.
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