Anders Tøttrup1. 1. Department of Surgery P, Aarhus University Hospital, Tage Hansensgade, 8000, Aarhus C, Denmark. anders_tottrup@hotmail.com
Abstract
BACKGROUND: Control of bowel effluents is imperative in cases of postoperative bowel perforation, and this is best achieved by stoma formation. When stoma formation is impossible, the surgeon is often left with less optimal choices. We have used a Foley catheter enterostomy to provide source control in difficult cases of bowel perforation, and the details are reviewed in this report. METHODS: Three patients underwent reoperation for postoperative bowel perforation. Two patients had leaking ileocolic anastomoses, and one patient had a leak from a serosal tear. In all cases a Foley catheter enterostomy was constructed at the point of the leak. The balloon was filled with 3 ml of saline, and the affected bowel segment was fixed to the inside of the abdominal wall by a purse-string suture supplied with a few additional stitches. Moreover, gentle traction was applied to the balloon by external suture fixation of the catheter. RESULTS: Immediate control of bowel effluents from the leak was achieved in all cases. Early enteral feeding was possible in two of the three patients, and the catheter was removed after 17-28 days. Drainage of bowel contents from the catheter wounds stopped within 2 days. CONCLUSIONS: This report demonstrates an effective and safe technique for sealing a postoperative bowel perforation with a Foley catheter enterostomy. It is useful in cases where a stoma cannot be brought out. The technique provides immediate source control and enables early enteral feeding. The utility of the procedure may be limited when the defect is large, when the surrounding bowel wall lacks integrity, and when it is not possible to mobilize the affected bowel segment toward the inside of the abdominal wall without tension.
BACKGROUND: Control of bowel effluents is imperative in cases of postoperative bowel perforation, and this is best achieved by stoma formation. When stoma formation is impossible, the surgeon is often left with less optimal choices. We have used a Foley catheter enterostomy to provide source control in difficult cases of bowel perforation, and the details are reviewed in this report. METHODS: Three patients underwent reoperation for postoperative bowel perforation. Two patients had leaking ileocolic anastomoses, and one patient had a leak from a serosal tear. In all cases a Foley catheter enterostomy was constructed at the point of the leak. The balloon was filled with 3 ml of saline, and the affected bowel segment was fixed to the inside of the abdominal wall by a purse-string suture supplied with a few additional stitches. Moreover, gentle traction was applied to the balloon by external suture fixation of the catheter. RESULTS: Immediate control of bowel effluents from the leak was achieved in all cases. Early enteral feeding was possible in two of the three patients, and the catheter was removed after 17-28 days. Drainage of bowel contents from the catheter wounds stopped within 2 days. CONCLUSIONS: This report demonstrates an effective and safe technique for sealing a postoperative bowel perforation with a Foley catheter enterostomy. It is useful in cases where a stoma cannot be brought out. The technique provides immediate source control and enables early enteral feeding. The utility of the procedure may be limited when the defect is large, when the surrounding bowel wall lacks integrity, and when it is not possible to mobilize the affected bowel segment toward the inside of the abdominal wall without tension.