What is a fecal diversion procedure?

From the Guidelines

A fecal diversion procedure, in the context of Fournier's gangrene, refers to a surgical intervention such as colostomy or the use of a fecal tube system with or without negative pressure therapy, aimed at diverting fecal matter away from the wound to reduce contamination and promote healing. This procedure is considered in cases where there is fecal contamination, as it helps in decreasing sepsis by minimizing the bacterial load in the perineal wound, thus controlling infection 1. The goal of such a procedure is to improve outcomes in patients with Fournier’s gangrene, a severe and potentially life-threatening condition characterized by necrotizing fasciitis of the genital and perineal area.

Key points to consider about fecal diversion procedures in this context include:

• They are recommended for cases of Fournier’s gangrene with fecal contamination to reduce the risk of further infection and promote wound healing 1.
• The procedure can involve either a colostomy or the use of a fecal diversion tube, with the latter offering a potentially less invasive alternative 1.
• Fecal diversion tubes can be used in combination with negative pressure wound therapy (NPWT) for effective isolation of the wound from fecal contamination, as demonstrated by Estrada et al. 1.
• While diverting colostomy can improve outcomes by reducing sepsis, it does not eliminate the need for multiple debridements, nor does it reduce the number of these procedures 1.
• The decision to perform a fecal diversion procedure should be made on a case-by-case basis, considering the severity of the infection, the extent of tissue involvement, and the overall health status of the patient.

In clinical practice, the management of Fournier’s gangrene requires a multidisciplinary approach, including prompt antibiotic therapy, hemodynamic support, and early surgical debridement, alongside consideration for fecal diversion in appropriate cases 1. The choice of fecal diversion method depends on various factors, including the patient's condition, the availability of resources, and the expertise of the healthcare team.

From the Research

Fecal Distraction Procedure

There is no direct information available on a "fecal distraction procedure" in the provided studies.

Fecal Microbiota Transplantation (FMT)

However, the studies do discuss Fecal Microbiota Transplantation (FMT) as a treatment for recurrent Clostridium difficile infection (CDI). Key points about FMT include:

• FMT is a promising treatment for recurrent CDI, with studies showing its effectiveness in resolving CDI-associated diarrhea 2, 3, 4, 5.
• FMT can be administered via colonoscopy, with some studies using a single infusion and others using multiple infusions 3, 4, 5.
• The use of vancomycin in conjunction with FMT has been explored, with some studies showing that a combination of FMT and vancomycin can be effective in treating severe CDI 3, 5.
• Factors such as donor selection, FMT preparation, route, timing, and number of administrations are important considerations for the effectiveness of FMT 2.

Gastrointestinal Symptoms Post-FMT

Some studies have also investigated gastrointestinal symptoms after successful FMT, including:

• Altered bowel habits, such as constipation, bloating, and loose stools, are common after FMT 6.
• Factors associated with gastrointestinal symptoms post-FMT include younger age, baseline history of irritable bowel syndrome, and preexisting inflammatory bowel disease 6.