A Case of Idiopathic Stomal Fistula Developing in a Very Elderly Patient 23 Years after Miles' Operation

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  • 腹会陰式直腸切断術後23年目に発症した特発性人工肛門皮膚瘻孔の1例
  • 症例 腹会陰式直腸切断術後23年目に発症した特発性人工肛門皮膚瘻孔の1例
  • ショウレイ ハラ エインシキ チョクチョウ セツダン ジュツゴ 23ネンメ ニ ハッショウ シタ トクハツセイ ジンコウコウモン ヒフロウコウ ノ 1レイ

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Abstract

A 90-year-old woman who had undergone Miles' operation for rectal cancer 23 years earlier was hospitalized for dementia and disuse syndrome ; while at hospital, she developed fever of unidentified cause and frequent leakage of feces from her ostomy pouch. She was referred to our hospital for treatment. We found a fistula around the stoma. Abdominal CT revealed a subcutaneous abscess around the stoma and stomal stenosis. We performed a seton procedure. A gastrointestinal barium series revealed the absence of any diverticula in the sigmoid colon. Therefore, we made the diagnosis of idiopathic stomal fistula. Although we dilated the stoma after the operation, the fecal fistula failed to improve. The patient continued to have frequent leakage of feces from the ostomy pouch. We changed the pouch to a one-piece ostomy system every 2-3 days and the problems resolved. She was transferred to her earlier hospital on the 28th postoperative day. While the abscess cavity was becoming smaller, the seton loop cut through the skin inside the loop and the fistula became an excretory duct. While under observation for that process, she has had no stomal troubles during the 10 months since the operation.<BR>We report this case in which the seton procedure in a very elderly patient whose activities of daily living had deteriorated because of idiopathic stomal fistula resulted in avoidance of reconstruction of colostomy.

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