Intussusception after Emergency Colostomy

Abstract

An analysis by Dandy in 1926 showed that 25 cases of -spinal osteomyelitis with extradural abscess had been reported up to that time. Only two of the patients recovered, and except in one case there was " no evidence to indicate that the nature of the lesion was more than roughly guessed" (Taylor and Kennedy, 1923). -The concluding words are also of interest: "Whether an epidural abscess may eventually be diagnosed before implication of the spinal cord and before the appearance of a spinal block remains to be seen."Numerous authors since that date have recorded cases successfully diagnosed and surgically treated (Abrahamson, McConnell, and Wilson, 1934; Stammers, 1938;Browder and Meyers, 1941).As late as 1944, however, when the clinical syndrome had long been accurately defined in the literature, Boger states: " From the literature, as we have reviewed it, there are 84 operated cases with a mortality of 35%." All authors agree that in non-operated cases the disease is invariably fatal. The mortality, then, can reasonably be associated with delay in making the diagnosis-a state of affairs less likely to obtain when the clinical syndrome of fever, spinal muscle spasm, and pain in the back of rapid onset and in a site where alternative possibilities are rare gains more general recognition. The coincident osteomyelitis of the spine and incipient neurological signs are indications for surgery without delay.The surgical technique, when reported, has been that common for all abscesses-namely, incision (by an extensive laminectomy to the limits of the extradural abscess) and drainage, either by repeated packing or by a large-bore drainage-tube (Stammers, 1938;Mixter and Smithwick, 1932 Jan. 20.-Temperature, pulse, and respiration normal. The left paralaminal musculature opposite L 3-4 was more acutely tender than on the previous day and showed slight swelling and increase in local heat. There was no tenderness over the spinous processes. A diminution was noted in the left ankle-jerk.Jan. 21.-An exploration by needling showed thick creamy pus in the paravertebral groove deep to the area of tenderness. Skiagrams failed to demonstrate any bony lesion in the lumbo-sacral vertebrae and there was no distortion of the psoas shadow. As the left ankle-jerk was still noticeably weaker than the right a diagnosis was made of osteomyelitis of the lumbar spine with cxtradural abscess.Jan. 22.-The bacteriological report showed that Staphylococcus aureus had been isolated in the pus. No tubercle bacilli were seen in Ziehl-Neelsen films. Operation was therefore undertaken without delay. A midline incision was made from L 2 to S 1. Thick creamy pus was found in considerable quantity deep to both erector spinae muscles. The laminae of L 3, 4, and 5 were soft and necrotic and were removed, releasing an extradural abscess of thick pus, extending up to L 2 and down to S 1. It had not separated the close dural attachment to the posterior common ligament except inferiorly. The dura over an equivalent area was covered by fleshy greyish-red gra...

Appendix and ascending colon intussusception through a prolapsed transverse colostomy: A case report with literature review

“…An intussusception through a prolapsed colostomy should be differentiated from just prolapsed stoma. Although clinical characteristics that may raise suspension of intussusception include significant irreducible prolapsed segment along with reduced stoma output, patients may present with non-specific symptoms like abdominal distention, vomiting suggestive of intestinal obstruction, or ischemic changes of prolapsed bowel [7] , [8] , [9] , [10] , [11] .…”

“…The intussusception of the small bowel and colostomy prolapse is rare. There have been only five similar reported cases [7] , [8] , [9] , [10] , [11] .…”