Temporary Witzel enterostomy in decompensated small-bowel obstruction or paralytic ileus

The technique of temporary Witzel enterostomy and its indications are reported and results in 81 patients (99 enterostomies) retrospectively reviewed. The procedure is recommended as an adjunct to primary surgery in cases of small-bowel obstruction with severe distention, extensive peritoneal defects and compromised vascularity, in paralytic ileus due to generalized peritonitis and in peritoneal carinomatosis. With the Witzel tunnel, postoperative bowel paralysis can be prevented, endangered anastomosis protected, bowel function directly monitored and long-term intestinal decompression achieved in patients with obstruction due to peritoneal carcinomatosis. The tube is easily removed when bowel function has normalized. The overall mortality in the series was 25% and the rate of enterostomyrelated complications 10%. There were no enterocutaneous fistulas requiring surgical correction. Possible long-term complications due to narrowing at the enterostomy site could not be assessed. Carefully constructed Witzel enterostomy, used on suitable indications, is an effective procedure in the management of small-bowel obstruction and peritonitis.