Colostomy

All about colostomy and stoma.

1. Rana Shankor Roy
[email protected]
Stoma

Stoma: Stoma is an artificial opening or ‘mouth like’ to the exterior, the abdominal wall so as to drain
the content from the tubular structures inside, like bowel or ureter.
It is an one type of artificial fistula.
Types:
-Ileostomy: terminal 5 cm ileum is projected out, on to the skin of abdominal wall.
-Colostomy
-Cutaneous ureterostomy
-Ileal urinary conduit
- Vesicostomy


Colostomy

Colostomy: A colostomy (or ileostomy) stoma is an artificial opening made in the colon (or small
intestine) to divert faeces and flatus outside the abdomen where they can be collected in an external
appliance.
The purposes of colostomy include the following:
-Diverting fecal stream for some distal pathology, e.g. colonic perforation.
-To decompress the obstructed colon.
-Replacement of anus, e.g. carcinoma rectum.
Types:
According to the period of diversion According to the way of fashioning of colostomy
-Temporary (Usually loop colostomy)
-Permanent (Usually end colostomy)
-Terminal or end colostomy
-Loop colostomy
-Divine’s defunctioning colostomy

-Ostomy: Operation that connects the GI tract to abdominal wall skin or the lumen of another hollow organ.
-Stoma: Opening of the ostomy.
-Ileostomy effluent is usually liquid, whereas colostomy effluent is usually solid
-Ileostomy patients are more likely to develop fluid and electrolyte problems
-An ileostomy is usually sited in the right iliac fossa
-End-colostomy is usually sited in the left iliac fossa

2. Rana Shankor Roy
[email protected]
Temporary colostomy: Is done in conditions wherein diversion is required to facilitate healing
distally in the rectum or distal colon. And this is closed once the purpose is over. Site of temporary
colostomy is usually right hypochondrium and left iliac fossa. It can be loop colostomy or Devine’s
double-barrel colostomy.
Permanent colostomy: is always end colostomy placed in left iliac fossa, 6 cm above and medial
to the anterior superior iliac spine.
Terminal or end colostomy: This is done at the sigmoid colon and opening is made at the left
iliac fossa. It is a type of permanent colostomy having a single stoma.
Loop colostomy: Here a loop of colon is taken out and colostomy is performed. It may be in the
sigmoid or transverse colon. It is a temporary colostomy and most commonly practiced.
Divine’s defunctioning colostomy: (A divided stoma colostomy or double barreled colostomy)
-The colostomy is made with a bridge of skin between the two stomas.
-Two limbs of the colon are brought out through separate skin incisions.
-The proximal stoma is thus an end colostomy while distal one is called a mucous fistula.
-This ensures absolute rest to the distal segment of the colon and rectum but restoration of bowel
continuity is more difficult.

Indications:
-Congenital:
High anorectal anomalies where the child is born with obstruction.
-Traumatic:
Injuries to the rectum and anal canal (to prevent faecal peritonitis) (. Here sigmoid colostomy is done)
-Inflammatory:
In some complicated cases of fistula in ano
Diverticulitis.
-Neoplastic:
Carcinoma rectum and anal canal(sigmoid colostomy is done)
Carcinoma descending colon (transverse colostomy is done.)
-Miscellaneous:
Colonic obstruction
Rectovesical or rectovaginal fistula.
Temporary colostomy Permanent colostomy
-Congenital megacolon
-Anorectal malformations.
-Sigmoid volvulus
-Perforation of left sided colon
-Left sided colonic growth
-High anal fistula
-Trauma to left sided growth
-AP-Resection.
-Carcinoma anal canal
-After Hartmann’s operation

3. Rana Shankor Roy
[email protected]
General Care and Advice to Patients with Stoma:
-Patient can have normal diet. Diet, which regulates the bowel action, is better.
-Plenty of water is advisable.
-Patient can go for normal work, exercise like sports, swimming.
-Antidepressants, anticholinergics might cause constipation. So these drugs should be taken carefully.
-Patient can have normal sexual activity.
Complications of colostomy:
-Prolapse of mucosa (prolapse of distal loop mucosa is common)—commonest complication
-Skin irritation/excoriation( due to leak adjacent to appliances. Other causes may be Wet skin before
placing the appliance, Infection like of bacteria and candida)
¬Retraction
-Ischaemia
-Stenosis
-Parastomal hernia
-Bleeding
-Fistulation

Colostomy closure:
-Colostomy closure is most easily and safely accomplished if the stoma is mature, typically after the
colostomy has been established for two months.
-Criteria for temporary colostomy closure:
-Integrity of distal colon should be normal and adequate.
-Anorectal sphincter should be normal.
-Cause for construction of colostomy is cured completely without any suspicious of recurrence of
same disease distally
Types of closure:
-Extraperitoneal
-Intraperitoneal type (Now intraperitoneal closure is done.)
Ileostomy appliances tend to be drainable bags, which are left in place for 48 hours, while
colostomy appliances are simply changed two or three times each day
Why doesn’t an ileostomy or colostomy close?
-Due to Epithelialization (mucosa to skin)