Colonic resection + stomas

Question 1

Describe the indications for colectomy

Answer 1

• Colorectal cancer
• IBD
• Bowel obstruction
• Perforation eg. trauma
• Diverticular disease: haemorrhage, complication
• Any cause of bowel necrosis eg. ischaemia

Question 2

Describe the types of colectomy

Answer 2

• Subtotal colectomy (colon not rectum)
• Pan-proctocolectomy: colon + rectum
• R + right extended vs L hemicolectomy eg. ascending + descending colon cancers
• Anterior resection: remove sigmoid + upper rectum
• Hartmann’s: remove sigmoid + rectum, form stoma + rectal stump
• Abdominoperineal resection: remove sigmoid, rectum + anus

Question 3

Which colectomies require stoma and which do not?

Answer 3

NO stoma:

• R hemicolectomy *may have temp
• L hemicolectomy *may have temp
• Anterior resection *temporary ileostomy formed

NEEDS stoma:

• Abdominoperineal resection: end-colostomy
• Subtotal/panproctocolectomy: end-ileostomy
• Hartmann’s: colostomy

Question 4

What is a primary anastomosis?

Answer 4

Where the anastomosis is done during the same procedure as the resection

Question 5

Describe the 3 steps of a Hartmann’s procedure

Answer 5

1. Transection of colon
2. Formation of an end-colostomy
3. Formation of a rectal stump

Question 6

Define a stoma

Answer 6

An artificial opening of a hollow organ

Question 7

Describe the differences between an ileostomy and colostomy

Answer 7

Ileostomy: usually RIF, spouted, more liquid contents
Colostomy: usually LIF, flush, more solid contents

Question 8

Describe how to distinguish an APR and Hartmann’s on examination

Answer 8

Both have stoma in LIF

APR will have no anus/sutured perineum

Question 9

What is a loop colostomy/ileostomy? When is it used?

Answer 9

Where a loop of bowel is brought to the abdominal wall and one side is open to the skin (forming 2 openings)
Temporary, to allow distal bowel to rest/heal

Question 10

Describe the complications of stomas

Answer 10

Psychological impact
High output stoma + dehydration + malnutrition
Constipation
Stenosis 
Herniation, retraction, prolapse
Skin irritation, bleeding, granulomas

Question 11

When are the two types of ileostomy performed?

Answer 11

End-ileostomy:
-Pan-proctocolectomy

Loop ileostomy:

• Anterior resection
• To allow bowel rest

Question 12

Describe the complications of colonic resection

Answer 12

Intra-operative: bleeding, damage to surrounding areas
Anaesthetic
Short term post-op: pain, wound infection, DVT, anastomotic leak, pneumonia, change in bowel habits
Long term post-op: (see other Q), scars, adhesions

Question 13

What is a high-output stoma?

Answer 13

Variable definition

> 1-1.5L in 24 hours

Question 14

Describe the management of a high output stoma

Answer 14

-Fluid resus + correct electrolyte imbalance
-Monitor fluid status + U+Es
+/- loperamide, PPI