Theme: Abdominal Stomas
MCQ: Select the Most Appropriate Stoma
A. End ileostomy
B. End colostomy
C. Loop ileostomy
D. Loop colostomy
E. End jejunostomy
F. Loop jejunostomy
G. Caecostomy
Scenario:
- A 56-year-old man is undergoing a low anterior resection for carcinoma of the rectum. It is planned to restore intestinal continuity.
Answer: C. Loop ileostomy
Explanation:
Why Loop Ileostomy?
- Procedure Context: Low anterior resection involves resection of the rectum with the creation of an anastomosis below the peritoneal reflection.
- Anastomotic Leak Risk: Anastomotic leaks occur in up to 15% of cases, which can lead to significant morbidity and mortality.
- Defunctioning Stoma: A loop ileostomy:
- Diverts fecal flow to protect the anastomosis during healing.
- Reduces the clinical severity of any potential leaks.
- Is relatively easy to reverse, making it an optimal choice in cases where intestinal continuity is planned.
Why Not the Other Options?
- A. End Ileostomy: A permanent stoma formed with the ileum, typically used in cases like proctocolectomy where intestinal continuity is not restored. It is inappropriate here, as restoration of intestinal continuity is planned.
- B. End Colostomy: A permanent stoma formed with the colon, usually done in abdominoperineal resection where the rectum is permanently removed. It is not suitable as this case involves a temporary solution.
- D. Loop Colostomy: A temporary stoma formed with the colon, used for defunctioning the colon in some cases. However, a loop ileostomy is preferred here because:
- It is easier to manage.
- It has a lower risk of complications such as prolapse or skin irritation.
- E. End Jejunostomy: A permanent stoma formed with the jejunum, generally used in upper small bowel obstructions or resections. It is irrelevant as the jejunum is not involved.
- F. Loop Jejunostomy: A temporary stoma formed with the jejunum, rarely used and inappropriate here as the jejunum is not involved.
- G. Caecostomy: A stoma formed with the caecum, used for decompression in specific cases of colonic obstruction. It is not applicable in this scenario involving rectal surgery.
Summary:
In low anterior resection with planned restoration of intestinal continuity, a loop ileostomy is the most appropriate choice. It effectively protects the anastomosis while healing and is easier to reverse compared to other options. Other choices are unsuitable due to their permanent nature, irrelevance, or higher complication risks.