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Percutaneous colostomy for treatment of mechanical bowel obstruction: factors affecting feasibility
1Department of Radiology 3890 JPP, University of Iowa College of Medicine, Iowa City 52242, USA.
Purpose:
To assess the feasibility of large-bore tube colostomy in the presence of bowel obstruction in a pig model.
Materials And Methods:
Porcine spiral colon was isolated, obstructed, pressurized to 18 mm Hg, punctured with 24-F radial dilators or balloon-sheath combinations in randomized sequences, and assessed for leakage. In another experimental set, T tacks were used. The effects of various drainage configurations and systems (open vs closed) on drainage and leakage were assessed during continued gut perfusion.
Results:
Pressurized colon leaked 0-19.8 mL during radial dilation, 0-210 mL during balloon-sheath dilation, and 7.4-29.8 mL/min at T-tack sites. Leakage increased with minor motion. Leak-free drainage during perfusion could be obtained only with open systems or with closed systems that were inserted at least 10 cm proximal to the obstruction.
Conclusion:
Percutaneous colostomy should only be attempted in very select cases with extreme attention to detail.