COLOSTOMY OBSTRUCTION DUE TO PERITONEAL CARCINOSIS

Bechaouech Nadia |

La tunisie chirurgicale - 2019 ; Vol 2019

Resumé

Preparing a colostomy with the objective of temporarily or definitively deviating colonic transit isnot a risk-free procedure even when performed with proper surgical technique. Localcomplications may appear in the immediate, early or late postoperative period, with an incidenceranging from 15 to 30% . Neoplasia is an unusual complication .

Mots Clés

Colostomie – carcinose péritonéale - obstruction

Introduction :

Preparing a colostomy with the objective of temporarily or definitively deviating colonic transit isnot a risk-free procedure even when performed with proper surgical technique (1,2). Localcomplications may appear in the immediate, early or late postoperative period, with an incidenceranging from 15 to 30% (1,2). Neoplasia is an unusual complication (3,4).

The appearance of malignant neoplasia in the colostomy site seems to be related to various

factors, among them colonic metaplasia secondary to a chronic inflammatory disease (3-5).

The presence of a metachronic neoplastic lesion, colectomy with inadequate safety margins,

colonic polyposis and the implant or recurrence of the tumor are also factors that lead to the

appearance of neoplasia in the colostomy site (5).

Considering that colostomy is an exteriorized segment of the colon with the same predisposingand provoking factors for development of a primary colonic tumor, it is accepted that theneoplastic risk is similar to that of any other portion of the colon, and is markedly elevated whenassociated with a metachronic lesion.

Clinically the presence of local tumor, intestinal bleeding and/or intestinal obstruction at the

colostomy site must attract attention.

As a rare but serious complication, we report a case of a patient who developed a neoplastic

lesion in the colostomy site. We describe its clinical manifestation and management.

Article

CASE REPORT:

A 75 year-old man, without particular medical history, had undergone a palliative left colostomyfor obstruction due to locally advanced colorectal cancer.

Four months later, he presented the emergency for abdominal pain and vomiting.

In physical examination, we found a peristomial bleeding mass on the colostomy opening (Fig.1).

CT Scan concluded to an ostomy obstruction due to a 2-3 cm parietal tumor (Fig. 2).

The decision was to perform a colostomy resection and confection of a new one.

The definitive histologic exam of the node has concluded to a peritoneal carcinosis (of the

colorectal adenocarcinoma).

 

CONCLUSION:

Neoplasia of the colostomy site rarely occurs. It has few but evident local clinical signs.

Its early diagnosis is the best way of controlling the disease.

The alert intervention of the stomatherapist and the surgeon, can determine a low morbidity andbetter chance of survival for the ostomized patient.

Figure 1: Ostomy aspect: peristomal bleeding and ulcerative tumor

Figure 2: Abdominal CT Scan: Tumoral lesion in the colostomy site

 

Références

1. Nour S, Beck J, Stringer MD. Colostomy complications in infants and children. Ann R

CollSurg Engl. 1996 Nov;78(6):526-30.

2. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum. 1998

Dec;41(12):1562-72.

3. Park JJ, Del Pino A, Orsay CP, et al. Stoma complications: the Cook County Hospital

experience. Dis Colon Rectum. 1999 Dec;42(12):1575-80.

4. Rothstein MS. Dermatologic considerations of stoma care. J Am AcadDermatol. 1986

Sep;15(3):411-32.

5. Shibuya T, Uchiyama K, Kokuma M, et al. Metachronous adenocarcinoma occurring at a

colostomy site after abdominoperineal resection for rectal carcinoma. J Gastroenterol.

2002;37(5):387-90.