Colostomy Types and Complications

Colostomy

Opening of the colon to the exterior, either temporary or permanent, for the drainage of faecal matter is called colostomy.

Colostomy Types

1. Colostomy Temporary Colostomy:

•  In cases of acute left-sided colonic obstruction, proximal half of right transverse colon is brought out through the upper part of the right rectus abdominis muscle. Later, radical resection of the left colon is done followed by closure of the colostomy.
•  In cases of traumatic or congenital fistula affecting the left colon, temporary colostomy is indicated
• The loop of the colon which is brought outside is held in place by a glass rod. This is passed through the transverse mesocolon and held by rubber tubing. This rod is removed after 10 days.
• Colostomy/ileostomy is done, if a distal colorectal anastomosis gives way

Ten Commandments

1. Should mark the colostomy site in the standing and sitting positions.
2.  Should be at least 3 cm away from the bony landmark (anterior superior iliac spine).
3.  Should be at least 3 cm away from the midline incision.
4. Otherwise, colostomy will contaminate the incision site.
5. Should close the paracolostomy space within the abdomen to prevent herniation of the small intestines.
6. Colostomy should be opened after 2 or 3 days and midline incision should be protected from getting infected due to bowel contents
7. Should be in flush with skin surface in the left iliac fossa.
8. Should excise a disc of skin for permanent colostomy
9. The stoma should be brought out through the rectus muscle.
10.  Should avoid bringing stoma outside through scar tissue.
11. Should examine the end of the colostomy for vascula

2. Permanent Colostomy:

• It is indicated after abdominoperineal resection where the end of sigmoid colon is brought outside in the left iliac fossa as permanent colostomy.
• The colostomy site should be 3 cm away from the anterior superior iliac spine so that colostomy bag can be fitted properly.
• End colostomy away from the main incisionTransverse colostomy is bulky, contents are semiliquid and difficult to manage—try to avoid it.

Permanent Colostomy—Left Iliac Fossa

• Avoid bony prominences
• Avoid belt lines
• Avoid marking in lying down position
• Avoid scars
• Avoid bringing out stoma lateral to rectus

3. Double-barreled Colostomy:

In this, the adjoining walls of the intestine are crushed. Both ends of the loop are defunctioned. This type of colostomy is not frequently done now. It was done earlier for sigmoid volvulus, resection of colonic stricture, etc.

Indications for Colostomy

• Congenital: In Hirschsprung’s disease and anorectal anomalies, temporary colostomy is done first.
• Carcinoma: Following APR, the permanent end-sigmoid colostomy is done.
• Colonic fistulae: Fistulae due to diverticulitis,
• Crohn’s disease or tuberculosis.
• Colonic injuries: Trauma due to stab injuries or operative injuries following nephrectomy, pelvic operations, PCNL (percutaneous nephrolithotomy).

Colostomy Advantages: Distal bowel takes complete rest, regains normal size and bacterial colonisation is reduced. It becomes empty and sterile so that chances of leakage at a later operation is reduced.

Colostomy Complications

• Bleeding, necrosis, retraction, prolapse, parastomal hernia and colostomy diarrhoea are some complications.
• Colostomy obstruction, gangrene