A Technical Description of Modified Wet Barrel Loop Colostomy in A Case of Recurrent Cervical Cancer After Exenteration

1. Introduction
The requirement of both fecal and urinary diversions in recurrent cervical cancer and primary or advanced and recurrent rectal cancer mostly has made the series of changes in the techniques (1). First pelvic exenteration was done in advanced carcinoma cervix in 1948. The procedure includes ultra-radical surgery including urinary tract and bowel reconstruction. Morbidity and mortality are the important concerns with this procedure. Perioperative mortality was shown upto 12% cases with morbidity ranging from 50-85% (2). Again in recurrent carcinoma cervix cases who were mostly priorly radiated enhances the complication rate and may need Laterally Extended Endopelvic Resection (LEER) (3, 4) With time there had been practice changing procedures in urinary reconstruction starting with ureterocolostomy at the onset though ileal conduit to double barrel colostomy and at last with wet double barrel colostomy. The complications like urinary tract infection, metabolic abnormalities (hyperchloremic and hypocalcemic acidosis), ascending kidney disease, and large volumes of watery malodorous stool with wet colostomy led to adoption of double barrel modification. Thus with double barrel colostomy, the retrograde urinary infection rate, febrile complications, semiformed stool output, single stoma compliance led to the acceptance of this procedure. (5,6) Exenterative procedures had better survival benefit than conservative surgeries (7).