B33. Enterostomies (colostomies, ileostomy) and their indications.

Page created on October 19, 2021. Not updated since.

Introduction

An enterostoma (or ostomy) is an opening between the intestine and the skin of the abdominal wall, formed by a procedure called an enterostomy. Faeces pass through the GI tract and out of the enterostoma, where an ostomy bag is attached to store it. They may be temporary (to be reversed later) or permanent. A temporary enterostoma is sometimes called a “diverting” one.

Many types of enterostomies exist, depending on the intestine which opens into the stoma:

  • Duodenostomy
  • Jejunostomy
  • Ileostomy
  • Colostomy

Indications

Enterostomies are necessary when:

  • After bowel resection, if the remaining bowel isn’t long enough to attach to the anus
  • A distal part of the GI tract needs temporary rest (due to inflammation, abscess, recent surgery with anastomosis)
  • A distal part of the GI tract is obstructed, and faecal drainage is needed (palliative or emergency)
  • Anal incontinence

In some cases, after colectomy, an ileal pouch can be made as a replacement to the colon, in which faeces can be stored. The ileal pouch is anastomosed to the anus. An ileal-anal pouch may be used instead of an enterostomy in some cases.

Types

Two major types of enterostoma exist, a loop stoma and an end stoma. With both types a small piece of bowel remains outside the abdominal wall, covered by the ostomy bag.

With a loop stoma, a loop of bowel is exteriorised (opened transversely but not transected). Then, the lumen of both the proximal and the distal limb are made to open into a common stoma opening. Loop stomas are mostly used for temporary stomas as it’s easier to reverse (as the bowel is not transected).

With an end stoma, a loop of bowel is transected. Then, only the proximal limb is made to open into the stoma opening. The distal limb is either removed completely or closed and will remain as a one-way tube, closed off from the proximal GI tract. End stomas are mostly permanent.

Complications

  • Dehydration and electrolyte imbalance
  • Peristomal skin irritation and maceration
  • Stomal retraction (below skin level)
  • Stomal prolapse
  • Stomal necrosis
  • Parastomal hernia

Having an enterostomy means a significant change in body image as well as changes in sexual activity, bowel gas management, travelling, and dietary limitations. Patients must be prepared for this and followed up regularly. Proper stoma care is important to prevent complications, and it’s important to educate patients on this.


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B34. Perianal abscesses and fistulae. Surgical management of hemorrhoids.

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