AJR 2003; 180:1330-1331
© American Roentgen Ray Society
A New Universal Colostomy Tip for Barium Enemas of the Colon
Jeffrey T. Williams1 and
Randall L. Scott1,2
1 Department of Radiology, The University of Tennessee Health Science Center,
800 Madison Ave., Memphis, TN 38163.
2 Department of Radiology, Veteran's Administration Medical Center, 1030
Jefferson Ave., Memphis, TN 38104.
Received September 18, 2002;
accepted after revision October 23, 2002.
Address correspondence to J. T. Williams.
Introduction
Despite various attempts to construct a safe and effective colostomy tip
with which to perform a colostomy barium enema
[1], many of the problems
inherent to this procedure still exist. There is a vast array of stomal
configurations postoperatively. This degree of variation could lead to the
inadvertent injury or perforation of the colon adjacent to the stoma during
intubation. The variability in stomal configurations creates an inherent
difficulty in developing a universal colostomy tip. In addition, the tip that
is currently used does not effectively occlude the stoma during the
examination, resulting in a suboptimal evaluation because the seal leaks and
the colon are not fully distended. Few advances have been made since 1982 when
Pochaczevsky [2] described a
colostomy device he developed. The objective of our article is to describe an
appliance that facilitates optimal examination of the ostomy and residual
colon. The colostomy tip that we developed is safe and effective and was
constructed from readily available low-cost materials, making it appealing to
all radiology departments.
Materials and Methods
The patient's residual colon is prepared for the examination according to
institutional protocol.
The colostomy device is assembled from the following materials: a nonlatex
retention cuff enema tip (Flexi-Cuff; E-Z-EM, Westbury, NY), a 22-French Foley
catheter (Bardex; C. R. Bard, Covington, GA), a "Christmas-tree"
connection adapter, and an insufflator (Cufflator; E-Z-EM).
Use a scalpel to cut the retention tip just distal to the binding strands
of the retention cuff. Make this modification as close to the cuff as
possible. Before using the device, insufflate the retention cuff with two
compressions to eclipse the rough edge of the tip and ensure the stoma is
protected. Advance the Foley catheter through the proximal connector of the
tip approximately 8 cm past the retention cuff. Use a hemostat or clamp to
pull the catheter through the tip because the "friction fit" is
snug. Insert the Christmas-tree connection adapter in the proximal end of the
Foley catheter, and secure the adapter to the catheter with adhesive tape.
Attach the insufflator to the tubing that extends from the retention cuff. To
maintain insufflation of the retention cuff, place a hemostat on the tubing
attached to the retention cuff. The device is now ready for use
(Fig. 1).
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Fig. 1. —Photograph shows components of assembled universal colostomy
tip: retention cuff (B), 22-French Foley catheter (F) (Bardex; C. R. Bard,
Covington, GA), nonlatex retention cuff enema tip (T) (Flexi-Cuff; E-Z-EM,
Westbury, NY), and "Christmas-tree" connection adapter (A). Note
that inflation port of Foley catheter (P) is never used.
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Either a physician or a well-trained radiology technologist should prepare
the stoma for examination by removing the colostomy bag and cleansing the
gross stoma. Inflate the retention cuff, and then gently insert the tip of the
Foley catheter into the stoma. The balloon of the Foley catheter should never
be inflated. Variations in patient anatomy and surgical technique result in
differing lengths and angulation of the distal colon to the level of the
ostomy stoma. These variations do not pose a problem with our device because
the Foley catheter can be easily adjusted by retracting it into the enema tip
at the point of insertion, thus customizing the length of the device to the
patient's anatomy. At this point, the patient's hand is placed over the
inflated cuff, which is opposed to the stoma. The cuff is easy to manipulate
between the patient's extended fingers, enabling the patient to provide
occlusive pressure to the ostomy. Once the examination is completed, the tip
can be easily removed and discarded.
Results
Safety is paramount. The possibility of perforating the colon with the
colostomy tip has been well addressed in the innovations described in the
radiology literature [2]. The
tip that we developed has been used for more than 15 years in our department.
None of our patients have had any complications associated with the use of
this device.
Discussion
This technique has many advantages. It is universal to all patients. The
catheter–nipple device described by Land
[3] can be difficult to use
because patient anatomy and surgical construction of the stoma vary. The use
of an adjustable Foley catheter for our device provides versatility to
overcome these two factors. In addition, the colostomy tip can be used to
easily study the proximal and distal colon through the stomal orifice, either
separately or simultaneously.
Pochaczevsky et al. [4]
described a technique for performing colostomy barium enemas in 1972. In 1982
[2], Pochaczevsky further
refined the process. We have potentially eliminated the problems that
Pochaczevsky continued to address in his 1982 work. We have eliminated the use
of any type of stomal adhesive because of its unreliability. The hydrostatic
pressure generated from the instillation of air and barium against the inner
aspect of the stoma compromises the integrity of the seal. The retention cuff
used in our device, when properly opposed to the surface of the stoma,
prevents contrast material from leaking. In addition, we eliminated the cone
from our device. The purpose of including the cone in previous devices was to
aid in retaining air and barium. The cone is not needed for our device.
Additionally, Pochaczevsky [2]
found that the cone makes the stoma vulnerable to injury. The absence of a
cone in our device furthers the notion of minimal invasion with technical
superiority.
In 1976, Goldstein and Miller
[5] relied on patient
cooperation for completion of an effective examination. We agree that patient
cooperation is needed. The retention cuff balloon of our device is easy for
the patient to grasp, thus allowing the appropriate titration of pressure to
be applied to occlude the stoma. In addition, the entire examination can be
performed with the patient in the supine or oblique position, and the
examination does not interfere with the patient's ability to grasp the
retention cuff to occlude the stoma.
Finally, our device is easy to assemble and cost-effective, and all the
components of our device are readily available in radiology departments. In
our department, several devices are preassembled. However, either a physician
or a technologist can assemble the device in less than 5 min.
Hopefully, our device will facilitate the performance of high-quality
colostomy enemas, thereby increasing physician and patient confidence in the
test results.
References
- Burhenne HJ. Technique of colostomy examination.
Radiology
1970;97:183
–185[Medline]
- Pochaczevsky R. A colostomy device for barium enema examinations.
Radiology
1982;143:565[Free Full Text]
- Land RE. Colostomy enema: description of a catheter-nipple device.
Radiology
1971;100:36[Medline]
- Pochaczevsky R, Meyers PH. A new, disposable catheter for selective
guided barium enemas: contrast examinations in patients with colostomies,
rectal lesions and fistulas and for pediatric colon studies. Am J
Roentgenol Radium Ther Nucl Med
1972;115:392
–395[Medline]
- Goldstein HM, Miller MH. Air contrast colon examination in patients
with colostomies. AJR
1976;127:607
–610[Abstract]
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Introduction
Materials and Methods
