Albert S. Lyons

Control of the colostomy

SummaryThe goal of colostomy control (of the sigmoid colostomy) is the attainment by the patient of security, normal activity, and freedom from the fear of fecal leakage. The sentinels which guard this security are psychologic adjustment, a well-constructed stoma, an efficient system of irrigation, a suitable interval between irrigations, and an adequate diet suited to the patient, which avoids diarrhea and produces constipation without impaction.

Mechanical management of the ileostomy stoma.

Full rehabilitation of the patient with an ileostomy depends on a well constructed stoma, efficient mechanical management, and psychological adjustment–all of which are interrelated. All members of the management team-surgeons, nurses, stomal therapist–should know something about the details of stomal management. This report deals with actual management of the ileostomy appliance and accessories, from the choice of a particular type of device to its fitting and use.

Operative correction of intestinal stomal difficulties

Abstract The causes of stomal difficulties may be psychologic, mechanical, physiologic, or anatomic. Operative correction was required in less than 10 per cent of cases. The principal conditions requiring operative correction of colostomy stomas were stenosis and herniation. The most common complications of ileostomy requiring revision were stenosis, prolapse, and interfering abdominal contours. A variety of surgical technics are available for prevention and correction of stomal difficulties caused by anatomic imperfections.

Intrarectal intussusception of the rectal mucosa

Abstract After a Thiersch operation for rectal procidentia, a clinical syndrome resembling intestinal obstruction occurred in two patients. Although the anal opening and rectal lumen easily permitted the passage of the sigmoidoscope, rectal tube and index finger after operation, flatus, liquid or formed feces could not be passed by the patient. This complication, apparently caused by an intrarectal intussusception, has not been hitherto described.After a Thiersch operation for rectal procidentia, a clinical syndrome resembling intestinal obstruction occurred in two patients. Although the anal opening and rectal lumen easily permitted the passage of the sigmoidoscope, rectal tube and index finger after operation, flatus, liquid or formed feces could not be passed by the patient. This complication, apparently caused by an intrarectal intussusception, has not been hitherto described.

Aids in finding adenomas at laparotomy

Abstract Our investigation of the value of the various aids in detection of polypoid new growths in the colon at laparotomy is still in progress. Because of our experimental work in dogs and limited clinical experience, we are presently inclined to use extended colotomy incisions in preference to, but not to the exclusion of, the other available diagnostic measures. The construction of a practical, flexible coloscope using fiber optics has been progressing very rapidly. This instrument promises to be an important investigative tool for the detection of intraluminal colonic disorders when used via the anus or through a small colotomy incision at laparotomy.