The abdominal colostomy gives a satisfactory functional result and, with adequate discipline, does not require any appliance or receptacle. Some patients adamantly refuse this component of the abdominoperineal resection and perforce have been subjected to a sphincter-saving operation which may not be adequate from a tumor standpoint. In several of these cases the mobilized descending colon has been brought to the perineum. A perineal colostomy may function as well as one implanted in the abdominal wall, but, in the absence of both the terminal rectal segment and the sphincter, leakage is common, and there is no mechanism to restrain the occasional peristaltic rush.
Interposed ileal segments have been clinically employed to span large gaps between colon and rectum where a direct anastomosis was not technically feasible. In Finsterer's review of 1952, fifty-two such operations, with only six deaths, had been reported in the world's literature.1 Experiments in dogs2-4