[Surgical complications of colostomies]

The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. Aim: reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence.A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients [7%] developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases [reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases], a necrosis in 5 cases [reconfection of the colostomy], a plicature in 2 cases [reconfection of the colostomy] a peristomal abscess in 2 cases [reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case] and a strangulated parastomal hernia in 1 case [herniorrhaphy]. The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course

[Treatment of acute colonic pseudo-obstruction [Ogilvie's syndrome]. Systematic Review]

Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14%% [level of evidence 4, recommendation grade C]. Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose [evidence level 2, grade recommendation B]. Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt, a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% [level evidence 4, recommendation grade C]. PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression [evidence level 2, recommendation grade B]. The cecostomy is more effective and safer than conventional colostomy [level of evidence 4, recommendation grade C]. The cecostomy is highly effective in colonic decompression but associated with a high mortality [level of evidence 4, recommendation grade C]. Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression