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Info


A. Purpose

  1. Permit egress of gastrointestinal contents
  2. Opening to any part of body for input of material
  3. Can be at any part of the gastrointestinal tract

B. Major Types

  1. Gastrostomy
  2. Jejunostomy
  3. Ileostomy
  4. Colostomy - usually cecum, transverse, sigmoid

C. Desired Characteristics

  1. Pink
  2. Protuberant
  3. Patent
  4. Productive

COLOSTOMY

A. Temporary
  1. Perforated diverticulum usually due to diverticulitis
  2. Rod inserted and brought bowel up for transverse loop colostomy
  3. Current therapy:
    1. Resect diverticulum
    2. Cut rectum and staple blind end closed = Hartman procedure with mucus fistula
    3. Bring end of sigmoid up to surface = colostomy
  4. Gunshot wound perforations

B. Complications

  1. Skin level obstruction
  2. Prolapse with intussusception - peristomal hernia
  3. Herniation
  4. Necrosis
  5. Weight gain due to salt and water retention of 3kg or more should be avoided [2]

C. Lifestyle

  1. Solid form stool from sigmoid colostomy
  2. Usually reasonably well tolerated
  3. A novel artificial bowel sphincter has been designed and tested fairly well [3]

ILEOSTOMY

A. Properties
  1. Very watery fluids
  2. Fluid highly alkaline causing skin problems
  3. End is ileum, must project beyond surface
  4. Should in Right Lower quadrant, at top of right rectus muscle

B. Conditions

  1. Inflammatory Bowel Disease: Crohn's or Ulcerative Colitis
  2. Total: polypectomy for familial polyposis; proctocolectomy
  3. Colon Carcinoma operation

C. Complications

  1. Skin irritation - erythema
  2. Separation
  3. Edema / Necrosis
  4. Obstruction
  5. Infection: for example, monilia
  6. Prolapse of stoma, fistula, hernia
  7. Recurrent Crohn's at stoma site

D. Diarrhea

  1. Osmotic
  2. Transport
  3. Intestinal Obstruction
  4. Sepsis
  5. Recurrent disease
  6. Short bowel syndrome

E. Continent Ileostomy

  1. Reservoir (Double bowel loop)
  2. "Intussusception"
  3. Tube into interior pouch
  4. Doesn't leak (not protrude)
  5. Cock pouch

F. Endo-Rectal Pull Through Procedure

  1. Treat for Ulcerative Colitis, Polyposis, Hirschsprung's Disease
  2. Anus intact, strip out rectal tissue (mucosa only)
  3. Ileo-anal anastomosis
  4. Results ~65% continence with control; 35% incontinent

References

  1. Turnbull GB and Erwin-Toth P. 1999. Ostomy Wound Management. 45(1A Suppl):23S abstract
  2. Lobo DN, Bostock KA, Neal KR, et al. 2002. Lancet. 359(9320):1812
  3. Vaizey CJ, Kamm MA, Gold DM, et al. 1998. Lancet. 352(9122):105 abstract