Colonic mucosal—submucosal blood flow and the incidence of faecal fistula formation following colostomy closure

Abstract

Summary: Fistula formation following closure of a colostomy occurs most frequently when closure is carried out within the first few weeks of construction and may be related to an impaired local microcirculation. Using a recently described method for measuring colonic mucosal—submucosal blood flow, the variations in local flow which occur during the first month after colostomy construction were determined in 8 patients. Mean blood flow increased from 6·9±1·8ml min−1 100g−1 (s.d.) at 7 days to 31·1±12·5ml min−1 100g−1 (s.d.) at 28 days. In a further 40 consecutive patients undergoing colostomy closure, blood flow measurements were made before operation. Eight patients developed a faecal fistula, and in 5 of these patients mucosal—submucosal blood flow was found to be less than 15ml min−1 100g−1. In every successful colostomy closure blood flow was greater than 15ml mi−1 100g−1. This study provides evidence that a subnormal blood flow is one of the factors associated with fistula formation following the operation of colostomy closure.