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GS38 General Surgery and Thoracic Surgery Other Conditions of the Large Intestine Toronto Notes 2019
Colostomy/Ileostomy
• Connection of proximal limb of colon or ileum to abdominal wall skin
Mucous Fistula
• Connection of distal limb of colon to abdominal wall skin
Ileal Conduit
• Connection of bowel to ureter proximally and abdominal wall distally to drain urine
Loop Colostomy
Investigations
• U/S,CTscan,fistulogram
• measureamountofdrainagefromfistula
Treatment
• decreasesecretion:octreotide/somatostatin/omeprazole
• surgicalintervention:dependentuponetiology(fornon-closingfistulas);uncertaintyofdiagnosis
Stomas
Definition
• anopeningoftheGItractontothesurfaceoftheabdomenwall
■ stomas can be constructed as either end stomas: the proximal end of the GI tract forms the stoma
and the distal end of the GI tract is not part of the stoma
■ loop stomas: a loop of the GI tract is brought up to the skin and the anti-mesenteric surface of the
bowel is matured as a stoma
◆ the proximal and distal GI tract remain in continuity
Ileostomy
• usuallypositionedinRLQ;ileumisbroughtthroughrectusabdominusmuscles
• indications:afterprotocolectomyforulcerativecolitis,insomecasesofCrohn’sdiseaseorfamilial
polyposis
• conventionalileostomy:dischargessmallquantitiesofliquidmaterialcontinuously,appliance(plastic
bag attached to a sheet of protective material) required at all times
• continentileostomy:reservoirisconstructedfromdistalileum,emptiedbyinsertingcatheterinto
stoma several times a day; rarely used, has mostly been replaced by ileal pouch anal anastomosis
Colostomy
• indications:todecompressanobstructedcolon,toprotectadistalanastomosisafterresection,orto evacuate stool after distal colon or rectum is removed
• colostomiescanbedonebymakinganopeninginaloopofcolon(loopcolostomy)orbydividingthe colon and bringing out one end (end colostomy)
• mostcommonpermanentcolostomyisasigmoidcolostomy–expelsstoolonceperday,noappliance required
• chronicparacolostomyherniaisacommoncomplication
Complications (10%)
• obstruction:herniation,stenosis(skinandabdominalwall),adhesivebands,volvulus • peri-ileostomyabscessandfistula
• skinirritation
• prolapseorretraction
• diarrhea(excessiveoutput),whichmayleadtofluid,electrolyteandnutritionalimbalances
Removed
Ileostomy Colostomy End Colostomy Figure 18. Ostomies
(Proximal) End Colostomy
(Distal) Mucous Fistula
Figure 17. End vs. loop colostomy
© Jean Yi-Chun Lin 2014
© Geoffrey Cheung 2010