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Ileostomy, Colostomy, and Gastroenteric Stomas
This chapter discusses ileostomies and colostomies. Gastroenteric anastomoses also are discussed in Chapter 41, Chapter 42, Chapter 43 and in Chapter 191 . Ileal pouch anal anastomoses are discussed in Chapter 93 .
Total or partial colectomy with resultant ileostomy or colostomy is performed primarily to treat inflammatory bowel disease (IBD), familial adenomatous polyposis (FAP), cancer involving pelvic organs, and abdominal trauma. Various types of ileostomies were performed in the past, such as the Kock pouch, but they are no longer popular and rarely used. Temporary colostomies are frequently performed for patients with acute diverticulitis and perforation. These patients often undergo repeat anastomosis and usually have a temporary colostomy for 3 to 6 months. Fig. 75.1 demonstrates the varied function of gastroenteric stomas, depending on the degree of resection.
Physiology of Gastroenteric Stomas.
Since the advent of the Brooke ileostomy, so-called ileostomy malfunction has rarely been seen. The major problem with ileostomy is electrolyte imbalance in the patient with gastroenteritis or food intolerance. After a colostomy has been established and the patient is properly educated to maintain it, colostomy function is compatible with a normal life pattern.
Clinical Picture
The problems of ileostomy occur when the output may be greatly increased, as occurs in any form of gastroenteritis. The patient can rapidly become dehydrated as the symptoms of abdominal pain and effluence increase but may be corrected when the gastroenteritis is treated.
Colostomy function, once established and regular, rarely represents any problems other than the care of the stoma and peristomal areas. In elderly patients who have undergone colostomy because of incontinence or severe constipation, managing the colostomy is a geriatric care issue. The clinician must always be aware of possible complications, such as intestinal obstruction, from other causes, such as adhesions or recurrent malignancy. When obstruction occurs, it is followed by the classic decrease in output through the ileostomy or colostomy, with resultant distention and all the signs of intestinal obstruction.
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