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05-03-2008, 05:26 AM
m Aim of Operation:
1- To bypass obstruction or perforation in the colon.
2- To prevent contamination in wounds of the left colon.
m Indications:
1. Congenital diseases: High anal anomaly or congenital megacolon.
2. Traumatic: Injury of the left colon or rectum. Rectal laceration following forign body removal is an indication for colostomy.
3. Inflammatory bowel disease: Ulcerative colitis, Diverticulitis or Bilharzial pericolic mass.
4. Neoplastic:
a) For preresection preparation in obstructed cases, to deflate colon in unsure colonic anastomosis.
b) Terminal colostomy after excision of the anal canal , rectum and sigmoid.

m Types:
1- Proximal colostomy (Simple loop colostomy):
2- Terminal colostomy.
3- Double barrel colostomy.
4- Defunctioning colostomy ( Devine 's colostomy)
m Complications:
1. Prolapse: Traction on the afferent loop and avoiding twist before fashioning of the colostomy help in prevention of prolapse. Refashioning of the colostomy may be needed for treatment
2. Retraction: A glass rod is passed between the loop and abdominal wall and stitches are taken to anchor the loop.
3. Stenosis: Muscle cutting incision can prevent. Repeated dilatation may be needed.
4. Peritoneal soiling: If it is opened early before sealing occurs.
5. Internal herniation: Obliteration of the gutter created between the abdominal wall and colon can prevent its occurrence.
6. Excoriation of the skin: Good care of the stoma and well fitted colostomy bag can prevent.
SOURCE: DR. AYMAN SALEM'S BOOK
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