Chapter 21. Loop Colostomy, End Ileostomy, and Loop Ileostomy

• To defunctionalize bowel.
• Protection of distal anastomosis.
• Relief of obstruction.

Absolute

• None.

Relative

• Carcinomatosis precluding mobilization of bowel.
• Morbid obesity such that mesentery or stoma cannot reach the skin surface.

• The patient should be supine.

• Stoma may appear dusky with edema during the first postoperative week.
• Enterostomal therapists can assist with patient education about appliance care as well as treatment of any peristomal skin irritation.

• Skin irritation from gastrointestinal contents.
• Ostomy retraction (common in obese patients).
• Mechanical obstruction due to an overly tight fascial closure around the stoma.
• Parastomal hernia.
• Prolapse.
• Fistula.
• Stenosis (may be treated with careful dilation).
• Necrosis of the ostomy due to ischemia (requires reoperation for resection).