Colostomy

Large Intestine
Dr Subhasish Paul
A colostomy is a connection of the colon to the skin of
the abdominal wall, mainly for the drainage of the
faecal matter.

Why colostomy is constructed on the abdominal wall

rather than in the perineum?
 no sphincteric control
 appliance can be maintained.

Colostomy are constructed as treatment for-

Obstructing lesions of distal large intestines
actual or potential perforations.

.
 Indications
Temporary colostomy
•Congenital Megacolon
•Anorectal Malformations
•Sigmoid volvulus
•Perforation of left sided
colon
•Left sided colonic growth
•High anal fistula
•Trauma affecting left colon
Permanent colostomy
•Abdominoperineal
Resection
•Carcinoma anal canal
•After Hartmann’s
operation
 Types by Anatomical location
End Sigmoid colostomy (most common)
End Descending colostomy ( preferred one)
Transverse Colostomy
Cecostomy

Proximal Colostomy (Rt colon) Distal Colostomy (Lt colon)

Right colon absorbs water and Few mass peristalsis
has irregular peristaltic Content is more solid
contractions Stoma output can be
↓↓ regulated by irrigation
Expels Liquid ,high volume and
foul smelling
Determination of Colostomy Location
Site for colostomy evaluated in
Standing
Sitting &
Supine position

Avoid
•Deep folds of fat
•Scar
•Bony prominences, so that the colostomy bags can be
fitted properly
 Types based on Function

To provide decompression To provide diversion of faecal

of the large intestine matter

Permanent Colostomy
Mainly Temporary Colostomy
Indications
Few Indications
•Distal bowel segment completely
•Distal Obstructing lesions
resected (AP Resection)
causing dilation of proximal colon
•Suspected perforation or
•Severe sigmoid Diverticulus with
obstruction of distal bowel
phlegmon
(obstructing carcinoma ,diverticulitis
•Toxic megacolon in selected
, leaking anastomosis or trauma)
paitiens
•Destruction/infection of distal
colon( Crohn,s disease or failed anal
sphincter reconstruction)
 Types of
Decompressing
Stomas

“Blow hole” Tube

Loop colostomy
colostomy cecostomy
“Blow hole” cecostomy / Transverse colostomy

Rarely done
Severely ill patients with massive distension &
Impending colon perforation
Choice of site of incision is mostly Distended cecum or
sometimes transverse colon
Disadvantages
Significant inflammation around the stoma
After few weeks intestinal prolapse may occur
Thus this type of colostomy is done for very short period of
time
Construction of blow-hole cecostomy or colostomy

About 4-6cm transverse incision is

given over the abdominal wall in
the most dilated part

Absorbable sutures between the

peritoneum and the seromuscular
layer of the bowel to be
decompressed which seals the
intestine from remainder of the
abdominal cavity

needle decompression of the gas-

distended viscus is performed to
reduce the tension on the intestinal
wall.
a second layer of absorbable sutures is
placed between the seromuscular layer of
the intestine and the fascia of the
abdominal wall.

Subsequently, the colon is incised, usually

with release of a large amount of
liquid and gas.
The stoma is completed by placement of sutures between
skin and colonic wall
Construction of a tube cecostomy

The cecostomy is constructed over the

most dilated aspect of the cecum
(similar to that used for a “blow hole”
colostomy)

A very large Malecot or mushroom-

tipped catheter is used and is placed in
the cecum
The catheter is secured within the cecum by two purse-string
sutures

↓↓

The tube is brought through a right lower quadrant incision.

The cecum then is sutured to the peritoneum of the abdominal
wall at the entry site of the catheter
******

Advantage – Less chances of prolapse

Disadvantage- the tube often gets blocked with faeces

 Loop-Transverse Colostomy
This type of colostomy is done in Mobile colon
It can’t be done if colon is massively dilated
possibility that the colostomy may become permanent

The stoma can be placed through the

rectus muscle either on the right or left
side, depending on later intentions of
closing or resecting the colostomy,
or it can be brought through the
midline
Tracheostomy tape is used to pull the loop of
colon through the incision
The fascia is then closed on either side of
the loop of colon tightly enough to allow
snug passage of one fingertip

The skin is then closed, on either side of

the loop of colon.

The tracheostomy tape is replaced by a

plastic rod/glass rod that frequently has a
suture/rubber tube through each end so
that it can be easily repositioned
The protruding loop of colon, which is
incised either longitudinally or
transversely to allow the best separation
of the edges of the colon

Full thickness of intestine is then sutured

to full thickness of skin with absorbable
suture material
 Closure of temporary colostomy
Temporary colostomy is usually closed after 3 months

Criteria for Temporary Closure

•Integrity the distal colon should be normal and adequate
•Anorectal sphincters should be normal
•Cause of construction of colostomy is cured completely without any
recurrence.

Two types of closures are present- extraperitoneal and intraperitoneal

type.

Intraperitoneal closure is the commonly advocated technique now

1. It is done by placing a circumferential incision over the margin with

skin edge to pull out the colostomy stoma.
2. Part adjacent to the skin is resected and anastomosed using Silk or
vicryl.
3. Sutured bowel is placed into the peritoneal cavity a drain is placed
4. The peritoneal cavity abdomen is closed in layers
 Construction of an End Colostomy(Diverting Colostomy)

An end, completely diverting, colostomy usually is located in the left

lower quadrant

The site usually is marked with ink in the patient’s room and then is
scratched into the skin with a needle in the operating room

An end colostomy most often is

constructed after removal of the rectum
for low-lying malignancy

The entire left colon is mobilized on its

mesentery
an opening in the abdominal wall is made at
the previously marked site by excising a 3
cm disk of skin

The fat, fascia, muscle, and posterior

peritoneum are incised longitudinally

The opening is then dilated, and the

closed end of the colon is pulled through
the abdominal wall
 excising the staple or suture line

chromic catgut sutures between the full thickness of colon and skin.

Once the stoma construction is complete, an appliance is applied in the operating

room