E0115 - Management of a Retracted Colostomy With Esophageal Stent

Award: Presidential Poster Award

Anasua Deb, MD, PhD¹, Busara Songtanin, MD¹, Zeyad Elharabi, MD², Dushyant Pawar, MD², Marawan Elmassry, MD², Malak Faragallah, MD², Kanak Das, MD^3
1Texas Tech University Health Sciences Center, Lubbock, TX; ²TTUHSC, Lubbock, Lubbock, TX; ³Texas Tech University Health Sciences Center and University Medical Center, Lubbock, TX

Introduction: Stoma retraction resulting from inadequate mobilization of the colon is seen in 1-6% patients undergoing colostomy. It is usually managed by surgical revision. We discuss successful management of such a case unamenable to surgical revision by an esophageal stent placement.

Case Description/Methods: A 36-year-old obese man with paraplegia from gunshot wound, stage 4 sacral decubitus ulcer, and urostomy tube placement presented to ER with fever, vomiting, diarrhea and infection of his sacral wound. He was diagnosed with osteomyelitis of the right ischium and inferior pubic ramus. To avoid fecal contamination of sacral wound, surgery created a diverting sigmoid loop colostomy which five days later retracted deep to the level of fascia along with gross fecal leakage through a fistulous track at the laparotomy site. A revision of the retracted colostomy was unsuccessful due to dense intra-abdominal adhesions. (Figure 1).



Gastroenterologic evaluation with a colonoscopy through the stoma showed a moderately stenosed retracted colostomy with gross fecal leakage through mid-line wound. A 23 mm x 155 mm fully covered esophageal stent was then placed within the afferent loop (descending colon) of the colostomy to divert the fecal matter to colostomy bag. (Figure 2). The outer end of the stent was sutured to abdominal wall skin. Following this, fecal leakage stopped completely through the mid line wound, and he was discharged home. Over the next three weeks, his course was complicated by an episode of external migration of the stent addressed with similar stent replacement followed by fixation of the inner end of stent to the colon wall using lassoes and resolution endo-clips, and the outer end to the abdominal wall skin with surgical sutures. He continues to do well as of today on a regular yet stent favorable diet along with a bowel regimen with Miralax producing a good stool output through colostomy, and to date, there was no fecal leakage through the mid line wound.

Discussion: Stoma retraction is a common early post-colostomy complication often requiring months to heal with conservative management with frequent wound care. Surgical revision of retracted stoma or creation of an upstream stoma was not possible in our case due to dense adhesions. A covered esophageal stent was thus placed for the management of the retracted stoma with a favorable outcome thus far. Review of literature showed only one case using esophageal stent in similar clinical scenario with a successful clinical outcome.



Disclosures:


Anasua Deb, MD, PhD¹, Busara Songtanin, MD¹, Zeyad Elharabi, MD², Dushyant Pawar, MD², Marawan Elmassry, MD², Malak Faragallah, MD², Kanak Das, MD³. E0115 - Management of a Retracted Colostomy With Esophageal Stent, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.