Introduction

Neurogenic bowel dysfunction is a frequent consequence of spinal cord injury/disease (SCI/D). A colostomy is considered when conservative treatments fail [1, 2]. In the last year we observed several SCI/D persons with colostomy, admitted to our institution with multiple complications.

Case presentation

We present four cases of SCI/D persons treated with Hartmann’s procedure and admitted to our institution for pressure ulcer (PU) treatment. All patients underwent PU surgery with good results. All patients reported a subjective good evacuation setting. No one assumed laxative therapies at home. At admission, all patients underwent abdominal radiography that showed an important constipation, with cases of sub-occlusion or complete occlusion with gastroparesis. One person presented a parastomal, strangulated hernia and underwent hernia reduction and patch positioning around the stoma. During hospital stay, bowel management required an important administration of laxatives and frequent, almost daily, stoma washes.

Discussion

Some considerations must be made regarding the use of traditional techniques in SCI/D people, such as Hartmann’s, leaving a large part of the colon and the anatomical position of the stoma itself represent limitations to fecal progression and may cause constipation. A specific approach, tailored on the SCI/D patients’ characteristics, such as the one described by our group, should be considered. Even if colostomy has been performed, appropriate therapies and health education on how to manage the stoma are fundamental to prevent complications.

中文翻译：

---

“传统”结肠造口术脊髓损伤患者的并发症：病例系列

 介绍

神经源性肠功能障碍是脊髓损伤/疾病 (SCI/D) 的常见后果。当保守治疗失败时，可考虑进行结肠造口术 [1, 2]。去年，我们观察到几位接受结肠造口术的 SCI/D 患者因多种并发症入住我们机构。

 案例展示

我们介绍了 4 例 SCI/D 患者接受 Hartmann 手术治疗并入住我们机构接受压疮 (PU) 治疗的病例。所有患者均接受PU手术，效果良好。所有患者均报告主观疏散环境良好。没有人在家中接受泻药治疗。入院时，所有患者均接受腹部X光检查，结果显示严重便秘，部分闭塞或完全闭塞病例伴有胃轻瘫。一名患者出现造口旁绞窄性疝气，并在造口周围接受了疝气复位和补片定位。住院期间，肠道管理需要大量服用泻药，并且几乎每天都要频繁清洗造口。

 讨论

在 SCI/D 患者中使用传统技术时必须考虑一些因素，例如 Hartmann 患者，留下大部分结肠，造口本身的解剖位置限制了粪便的进展，并可能导致便秘。应考虑根据 SCI/D 患者的特征量身定制的具体方法，例如我们小组所描述的方法。即使已经进行了结肠造口术，适当的治疗和有关如何管理造口的健康教育也是预防并发症的基础。