Types of colostomy

Types of colostomy

Loop colostomy Loop stomas are most commonly used to temporarily divert the faecal stream; for instance, to protect an anastomosis (usually by a loop ileostomy) following traumatic injury to the rectum, to facilitate the operative treatment of a high anal fistula, for incontinence and to defunction an obstructing void low rectal cancer prior to long-course chemoradiotherapy . A mobilised loop of colon is brought out onto the anterior abdominal wall. Once the abdomen has been closed, the - colostomy is opened and the edges of the colonic incision are - sutured to the adjacent skin margin ( Figure 77.18 ). A rod or bridge is sometimes placed under the loop to prevent retrac - tion in the early postoperative period, being removed after a few days. Colostomy function should be expected in 2–7 days after operation.

Figure 77.18 Loop colostomy with a bridge.

porary stoma was constructed, the colostomy can usually be closed without recourse to a laparotomy/laparoscopy . Conven tionally a water-soluble contrast enema is performed to assess the distal bowel before closure, particularly for pelvic anasto moses. A pproximately 25% of temporary diverting stomas are never closed because of complications or changes in medical comorbidity . End-colostomy This is formed after an abdominoperineal excision of the rectum or as part of a Hartmann’s procedure, bringing the divided colon through a left iliac fossa trephine in rectus abdominis and the skin. The colonic margin is then sutured usually flush or slightly everted on the adjoining skin ( 77.19 ). Double-barrelled colostomy (Paul–Mikulicz) Occasionally , when resection of a section of colon has occurred but the patient is too ill to undergo a safe reanastomosis it is possible and appropriate to bring up both ends of the bowel to the abdominal wall (see Volvulus ). This aids subsequent closure as the ends can simply be mobilised locally and reanas tomosed rather than the patient requiring a relaparotomy . Summary box 77.15 Stomas /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Stoma output is collected in disposable adhesive bags. Colos - - tomy appliances are simply changed as necessary . A wide range of such bags is currently available. In most hospitals, a stoma - care service is available to o ff er advice to patients, to acquaint them with the latest appliances and to provide the appropriate psychological and practical help.

Figure 77.19 A colostomy in the left iliac fossa. May be colostomy or ileostomy May be temporary or permanent Temporary or defunctioning stomas are usually fashioned as loop stomas An ileostomy is spouted; a colostomy is /f_l ush or slightly everted Ileostomy ef /f_l uent is usually liquid whereas colostomy ef /f_l uent is usually solid Ileostomy patients are more likely to develop /f_l uid and electrolyte problems An ileostomy is usually sited in the right iliac fossa End-colostomy is usually sited in the left iliac fossa Whenever possible patients should be counselled and sited by a stoma care nurse before their operation