Colostomy of the Ascending Colon or Cecum *

The establishment of a vent from the right colon to the outside is the objective of the operative procedure commonly called "cecostomy." The operation is usually performed in the presence of obstruction of the distal colon. The following observations are therefore pertinent: (1) With this operation, as with any other, the true objective must be kept constantly in mind. A safe and direct technic is desirable. Additional maneuvers not contributing directly to the attainment of the objective are superfluous and often dangerous. (2) There is no basis in fact that such a vent must be made through the cecum specifically. Any portion of the ascending colon will serve as well, provided it is proximal to the obstruction. (3) Intra-abdominal exploration is in the great majority of instances not a part of the objective. When such exploration is combined with the main procedure the patient is subjected to multiple operations, only one of which is indicated at the moment. The mortality rate rises sharply when exploration is added -to surgical decompression of the right colon. (4) The simplest maneuver which effectively seals the colon in the region of the fistula to the adjacent parietal peritoneum is the one indicated. Additional "safeguards" are advisable only when they can -be performed without significant risk. Anchoring sutures between the peritoneum and the distended colon are among the commonly employed "safeguards" which are not only superfluous but also dangerous. They are superfluous because the peritoneal surfaces in question adhere within a few hours under the existing conditions of the operation. They are dangerous because with any suture material, and particularly with catgut, it is practically impossible consistently to place the suture within the thinned wall of the distended colon without perforating the full thickness. Such perforation results in the escape of liquid feces into the peritoneal cavity or into the abdominal wall. (5) An outside vent sufficiently large to permit the escape of gas and liquid feces is adequate. A larger opening increases the