Colostomy Flashcards
What are the indications for forming a colostomy
Diversion - to allow healing of a distal anastomosis or fistula by diverting faeces
Decompression - decompress a dilated colon before resection of the obstructing lesion
Removal - of distal colon and rectum
What are the different types of colostomy
Loop colostomy
End colostomy
Double barrelled colostomy
What is a loop colostomy
A loop of colon is brought to the surface and opened
Used temporarily to divert faeces
Simple to reverse
Why is a loop ileostomy preferred to a loop colostomy
Due to better blood supply to the bowel facilitating subsequent closure
What is an end colostomy
Formed by dividing the colon and bringing the proximal end to the surface
When is an end colostomy used
It is a definitive procedure
Used in:-
Patients having total rectal excision
Perforated diverticular disease (gross faecal contamination makes anastomosis undesirable)
What is a double-barreled colostomy
Proximal and distal end of colon brought to the surface
Like a loop colostomy but the middle section of colon has been removed
Why is a double-barreled colostomy not often used
As the distal bowel is usually too short
When is a double-barreled colostomy used
Treatment of a sigmoid volvulus
There is usually sufficient distal colon
What are the complications of a colostomy
Specific:-
Retraction - colon disappears down the hole it was brought out of
Stenosis - the stoma opening becomes smaller
Parastomal hernia
Prolapse - colon prolapses out of the stoma
Lateral space small bowel obstruction
Leakage with skin excoriation - due to ill-fitting appliances
General (related to underlying disease):-
Psychosexual problems
Residual disease
Nutritional disorders
What is real retraction
Retraction due to tension
What is apparent retraction
Retraction due to necrosis of the terminal bowel
What causes stoma stenosis
Ischaemia
Poor apposition of colonic mucosa with the skin edge
What is lateral space small bowel obstruction
Caused by failure to obliterate the space between the terminal colon and the lateral abdominal wall
What are the contents of the bag in a colostomy
Semi-liquid in the first few weeks after formation
Gradually reverts to normal, solid stools
