Management of Feces in a Colonic Continent Reservoir After Catheter Placement
The next best step after finding feces in a colonic continent reservoir 1 month post-op after catheter placement is to perform internal drainage through the catheter to facilitate emptying of the reservoir. 1
Understanding the Problem
When feces are found in a colonic continent reservoir after catheter placement, this indicates:
- Potential blockage or dysfunction of the drainage system 1
- Need for intervention to prevent complications such as infection or reservoir distension 1
- Possible maturation issues with the drainage tract (typically takes about 4-6 weeks for complete maturation) 1
Recommended Management Approach
Immediate Management
- Perform internal drainage through the catheter to facilitate emptying of the reservoir 1
- Irrigate the reservoir with saline solution to clear fecal material 1
- Ensure catheter patency by checking for obstruction 1
Catheter Management
- The catheter should remain in place as the drainage tract typically requires 4-6 weeks for complete maturation 1
- If the catheter is dysfunctional (unable to drain properly), consider catheter manipulation or upsizing 1
- Aggressive lavage of the collection via the catheter should be performed every 4-6 hours 1
Follow-up Interventions
- Consider imaging (CT with contrast) to evaluate the reservoir integrity and rule out complications 1
- Perform a cholangiogram-equivalent study through the catheter to assess patency of the drainage system 1
- Monitor for signs of infection including fever, increased white blood cell count, and local inflammation 2
Potential Complications to Monitor
- Infection of the reservoir requiring antibiotics 1
- Catheter dislodgement requiring repositioning 1
- Leakage around the catheter site 1
- Blockage of the drainage system 1
Long-term Management
- Teach the patient proper catheter care and reservoir emptying techniques 1
- Schedule regular follow-up visits to assess reservoir function 1
- Consider routine catheter exchange every 2-4 weeks until the tract is fully mature 1
- Monitor for improvement in symptoms and quality of life 3
Common Pitfalls to Avoid
- Premature catheter removal before tract maturation (should remain for at least 4-6 weeks) 1
- Leaving the catheter to continuous free drainage, which can prevent proper internal drainage 1
- Failure to recognize signs of reservoir infection requiring more aggressive intervention 1
- Inadequate patient education about self-management of the reservoir 1
Special Considerations
- If internal drainage fails to resolve the issue, consider endoscopic evaluation of the reservoir 1
- For persistent problems, surgical revision may be necessary, but this should be considered only after conservative measures have failed 1
- Patient-reported outcomes should be used to guide management decisions and assess treatment success 4