Colostomy performations by the irrigating tip

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Abstract
THE AUTHORS direct attention to the potential danger of perforation of the bowel faced by all patients who depend upon irrigations for a predictable evacuation. They venture the opinion that this accident occurs more frequently than reports in medical literature would appear to indicate. Their comprehensive report is based on the records of 14 patients in whom perforations occurred since 1950 and is limited to perforations caused by "self-irrigation '~ of the bowel. With the exception of one patient who was referred after perforation had occurred, all of their patients had been instrncted carefully regarding the technic of administering the irrigation and had demonstrated their ability to perform it. This potentially fatal accident usually is due to carelessness on the part of the patient, who appears to be inclined to insert more of the tip than is required and he does it despite instructions to the contrary. The patients in this series were warned not to insert the enema tube mote than three inches, yet some of the perforations occurred as much as six or eight inches proximal to the stoma. "Impatience and excitement," say the authors, "which sometimes occurs when the irrigation does not proceed as expected, apparently causes the patient to deviate from the routine he had been carefully taught." Six of the 18 accidents occurred within the first three months after the patient had been discharged from the hospital and there were none while patients were in the hospital under the guidance of the nursing staff. * Abridgment of original article read at the joint meeting of the American Proctologic Society and the Section of Proctology of the Royal Society of Medicine, Philadelphia, Pennsylvania, May 9 to 14, 1964. Increased hydrostatic pressure, weakening of the wall o£ the bowel caused by the erosive effect of enema tip or catheter, and rupture of a diverticulum have been mentioned as causes. The authors feel that these may be contributory factors but they are convinced that, in their group of patients, perforations were the result of forceful penetration of the bowel by the catheter tip in the hands of an impatient and excited person.

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