The role of intestinal stoma in patients with spinal cord injury

Abstract

In the long term following spinal cord injury, bowel dysfunction causes major physical and psychological problems. A retrospective review of intestinal stomas performed in patients with spinal cord injury over a 10 year period was performed to investigate their role in alleviating these problems. Twelve patients underwent left iliac fossa end colostomy and two patients right iliac fossa end ileostomy. The mean age of patients at operation was 54.8 years (20 ± 65), and the mean time from injury to stoma formation was 15 years (2 ± 37). The mean period of unsatisfactory bowel management before stoma formation was 5.4 years (1.5 ± 25). Following colostomy the mean time spent on bowel care per week fell from 8.8 h (0.6 ± 12.2) to 1.4 h (0.3 ± 3.5) and independence in bowel care rose from 50 to 92%. All patients stated that their bowel care was easier and 83% said their independence had increased. Ninety-two per cent wished colostomy had been o ered earlier and no patient undergoing colostomy wanted it reversed. The most common complication following colostomy was exclusion colitis. The mean time of follow-up post colostomy formation was 38 months (7 ± 130). Formation of an intestinal stoma is a safe, e ective and well accepted treatment for selected patients with intractable problems of bowel management following spinal cord injury.

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

“…Nine studies (aggregate N ¼ 590) examined the effect of colostomy after SCI (Table 11). [60][61][62][63][64][65][66][67][68] Given the ethical nature of this treatment (that is few safe options once they reach the point of [60][61][62][63][64] and Level 5 evidence (from one study) 68 that colostomy reduces the number of hours spent on bowel care. There is Level 4 evidence (from one retrospective pre-post study) 60 that colostomy greatly simplifies bowel care routines.…”

“…However, it is of importance to note that colostomy is a safe, effective method of managing severe and chronic GI problems, and perianal pressure ulcers in persons with SCI. Our systematic review shows that colostomies reduce the number of hours spent on bowel care, [60][61][62][63][64] reduce the number of hospitalizations caused by GI problems 63 and bowel care-related complaints, 60 simplify bowel care routine, 60 and improve quality of life. 62,63,67 In addition, many patients wished to have the colostomy performed earlier.…”

“…Our systematic review shows that colostomies reduce the number of hours spent on bowel care, [60][61][62][63][64] reduce the number of hospitalizations caused by GI problems 63 and bowel care-related complaints, 60 simplify bowel care routine, 60 and improve quality of life. 62,63,67 In addition, many patients wished to have the colostomy performed earlier. 64 As described by Safadi et al, 68 the left colostomy may be preferred because it preserves colic surfaces to absorb water and prevent dehydration; thus, feces are less liquid and discharges less frequently than with right colostomies.…”

Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury

“…Previous publications describe the formation of an intestinal stoma in SCI patients for management problems, including chronic gastrointestinal symptoms, 10 decubitus ulcers, 9 anal cancer, 10 rectal cancer, Stoma formation in SCI patients G Branagan et al trauma, 11 bowel obstruction, 11 and rectovesical fistula.…”

“…[1][2][3] The failure of conservative measures to treat these chronic problems in some patients has led to the use of elective surgical treatments such as anterior sacral root stimulation, 4,5 antegrade colonic lavage [6][7][8] and stoma formation. 9,10 The effect of colostomy formation on both quality of life 11 and time taken for bowel care 9,10 is well recorded, including data from our own group.…”