COLOSTOMIES

COLOSTOMIES

A colostomy is a planned opening made in the colon to divert faeces and flatus through the abdominal wall, where they can be collected in an external appliance. Ileostomies are discussed in Chapter 74 . Depending on the purpose for which the diversion has been necessary , a stoma may be temporary or permanent. Indications for stomas are shown in Summary box 77.14 . In elective surgery stoma counselling and siting should be performed by a trained stoma nurse. The patient should be examined lying, standing and sitting to determine the optimum site, which should be away from scars, skin creases and bony prominences. In obese patients the stoma should be sited higher so that it can be easily seen. Clothing preference Frank T Paul , 1851–1941, surgeon, Liverpool, UK. Johannes von Mikulicz-Radecki , 1850–1905, Professor of Surgery , Breslau, Poland. be considered. In the emergency setting siting may be di ffi cult with a sick and immobile patient, particularly if the abdomen is distended. Summary box 77.14 Indications for colostomy formation /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

To protect a distal anastomosis or allow healing away from the faecal /f_l ow Following resection when anastomosis is unsafe or not possible To relieve obstruction when resection is not feasible To reduce disease activity (e.g. Crohn’s disease) To allow alternative bowel control (incontinence)