Abstract No. 58 Interventional Radiology Management of Appendicostomy Stomal Stenosis

Patients with appendicostomy (Malone or NeoMalone) frequently develop stomal stenosis. In addition to surgical revision, minimally invasive recanalization can be used to rescue these stenotic stomata. The purpose of this project was to evaluate our institutional experience with minimally invasive recanalization techniques in children who develop stomal stenosis post appendicostomy. An institutional review board–approved retrospective review was performed to identify all patients who underwent recanalization for stomal stenosis after appendicostomy from 2019 through 2022. Electronic medical records were reviewed for clinical history and follow-up. Procedural imaging and notes were reviewed to describe the document and describe the different techniques. Thirteen patients (9M, 4F); mean age of 13 years (5-19) underwent 17 recanalization attempts. The mean time between the last successful catheterization and recanalization attempt was 24 days (range 1-120). Guidewire placement was confirmed fluoroscopically during all recanalization attempts and ultrasound imaging was used in select cases. Fifteen of 17 attempts were successful in establishing patency and allowing use of the stoma. Three different recanalization techniques were used. In 9/15, blunt recanalization was successful, 2/15 required the Lone Star retractor, and 4/15 required sharp recanalization. Two of 17 attempts were unsuccessful. There were no major complications; minor complications included contrast extravasation into the peritoneum in 3 attempts. Stomal patency was maintained in all but one patient post recanalization during the follow up period. Of the two recanalization unsuccessful attempts, one was found to have necrosis of the appendix during surgical revision, and the other was lost to follow-up. Stomal stenosis of appendicostomy can be successfully managed with non-surgical, minimally invasive interventional radiology techniques at a high rate.