Current indications for blow-hole colostomy:ileostomy procedure. A single center experience.
OBJECTIVE
Because of improved medical care and surgical techniques blow-hole colostomy with loop ileostomy is now rarely performed to reduce operative risks in patients with toxic megacolon related to inflammatory bowel disease (IBD). We reviewed patient charts to identify continuing indications for this procedure.


METHODS
Seventeen patients underwent blow-hole colostomy procedure with ( n=15) or without ( n=2) ileostomy (8 men, 9 women; median age 51 years, range 21-79) during the past 18 years (1983-2001).


RESULTS
The indications for the procedure were: toxic megacolon related to IBD ( n=6), toxic megacolon related to IBD and associated with pregnancy ( n=2), Clostridium difficile colitis ( n=3), adult Hirschsprung's disease ( n=1), pancreatitis with obstructing pseudocyst ( n=1), and palliation for malignant bowel obstruction with metastases ( n=4). Patients were discharged home after a median stay of 10 days (range 4-32 days). The 4 patients who underwent a palliative blow-hole procedure had died secondary to their underlying disease by the time of follow-up. Of the remaining 13 patients 12 had their alimentary tract reconstituted, and one still awaits a definitive procedure.


CONCLUSIONS
The blow-hole colostomy-ileostomy procedure is still indicated for select patients with toxic megacolon and large-bowel obstruction. The procedure acts as a bridge to definitive operation for toxic patients with benign disease and palliates those with malignant obstructions and metastasis.
Remzi
Feza H
FH
Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA. remzif@ccf.org
Oncel
Mustafa
M
Hull
Tracy L
TL
Strong
Scott A
SA
Lavery
Ian C
IC
Fazio
Victor W
VW
D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery; D008297:Male; D008532:Megacolon, Toxic / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies