DR. ASHOK PRADHAN DU, TU

1. INTESTINAL STOMAS
DR ASHOK PRADHAN
2ND YR JR SURGERY
UCMS,TH

2. INTRODUCTION
• INTESTINAL STOMA ia an opening of intestinal or urinary tract onto
abdominal wall
• Colostomy is connection of colon to the skin of abdominal wall and
ileostomy involves exteriorization of ileum on abdominal skin, rare cases
jejunostomy
• Urinary conduit involves a stoma on the abdominal wall that serves to
convey urine to an appliance placed on skin, conduit may consist of
intestinal segment

3. COLOSTOMY
Type by anatomic location
• End sigmoid colostomy
• End descending colostomy
• Transverse colostomy
• Cecostomy
Type by function
• Decompression of large
intestine
• Diversion of feces

5. Determination of colostomy location
• Avoid deep fold of fats, scars and bony prominences of abdominal wall
• Evaluating on different position
• Inguinal fold and waistline fold avoided
• Visible to the patient

6. Decompressing colostomy
• Indication
1. Distal obstructing lesion causing dilation of the proximal colon with out
ischemic necrosis
2. Severe sigmoid diverticulitis with phlegmon
3. Patient with toxic megacolon
• Bridge to the definitive tratment
• Disadvantage
1. Requires subsequent operation
2. Doesn’t provide complete fecal diversion, carries the risk of fatal sepsis if
there is distal perforation

7. Types of decompressing stoma
• Blow-hole decompressing colostomy constructed in cecum or
transverse colon
• Tube cecostomy
• Loop colostomy

8. Blow hole colostomy and cecostomy
 Reserve for severely acutely ill patient with impending perforation of the
colon( ederly and immuno-compromised)
1. Distal obstructing cancer
2. Pseudo-obstruction syndromes
• Disadvantage
1. Done through the small incision
2. Cannot evaluate other parts of colon for potential ischemic necrosis
3. Postoperatively significant prolapse after a period of week

10. Tube cecostomy
• Incision similar to that for blow hole colostomy
• Purse string suture is placed in cecal wall, and large mushroom tipped or
Malecot catheter placed in the cecum
• ADVANTAGE
 Less chance of prolapse
• Disadvantage
• Catheter usually become blocked with feces, drain poorly, sometime stool
leaks adjacant to drain

12. Loop transverse colostomy
• Loop colostomy used as decompressive stoma, although it usually completely
divert the flow of stool away from distal colon
• Indication
– obstructing Rectal cancer
– Diverticulitis
– temporary diversion for protection of distal anastomosis
• Disadvantage
– Liduid effulent
– Prolapse
– Retraction of stoma – feces from proximal colon spills over distal limb
• On emergency basis done for decompression of the most dilated part but it
can be done electively(low colorectal anastomosis)
• On elective basis preoperative planned should be made(right or left) /in
midline(sabiston)

14. Closure of temporary colostomy
• Important consideration should to be taken weather restoration of
intestinal continuity present or not
• Distal integrity and adequacy of sphinchter muscle function must be
evaluated
• Manometric and electromyographic studies
• 500ml of enema given to patient, hold if as much possible as he/she can
and comfortably walk to toilet and expel it
• If not then “permanent end colostomy”

16. Diverting(end) colostomy
• Indication
1. Distal segment of the bowel has been completely resected
(abdominoperineal resection)
2. Known or suspected perforation or obstruction of distal bowel
1. Obstructing carcinoma
2. Sigmoid diverticulitis
3. Leaking anastomosis
3. Destruction or infection of distal colon, rectum, anus
1. Crohn’s disease
2. Failed anal sphinchter reconstruction

17. Choice for construction
• If the rectum and anus have been completely resected – end colostomy
created
• If partial colectomy/proctectomy has been performed, end colostomy
created and distal bowel is closed( Hartmann precedure) or brought to
skin as mucus fistula

20. Colostomy management
Irrigation

21. Colostomy complication
• Stoma stricture - ischemia
• Colostomy necrosis
– Excessive resection of mesentery
– Excessive tension on mesentery
– Fascial opening too small
– Poor perfusion due to low fllow states
• Parastomal hernia
• Colostomy prolapse
• Colostomy perforation

22. Thank you