PERCUTANEOUS COLOSTOMY FOR TREATMENT OF MECHANICAL BOWEL OBSTRUCTION - FACTORS AFFECTING FEASIBILITY

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 i n randomized sequences, and assessed for leakage. In another experimen tal set, T tacks were used. The effects of various drainage configurat ions and systems (open vs closed) on drainage and leakage were assesse d during continued gut perfusion. RESULTS: Pressurized colon leaked 0- 19.8 mL during radial dilation, 0-210 mL during balloon-sheath dilatio n, and 7.4-29.8 mL/min at T-tack sites. Leakage increased with minor m otion. 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 shoul d only be attempted in very select cases with extreme attention to det ail.