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 23-year-old man with uncontrolled ulcerative colitis is undergoing an emergency subtotal colectomy.
Answer: A. End ileostomy
Explanation
Why End Ileostomy?
- Procedure Context: A subtotal colectomy involves removing most of the colon while leaving the rectum intact.
- Emergency Setting: An ileorectal anastomosis, where the ileum is connected to the rectum, is not safe in emergencies due to a high risk of complications like anastomotic dehiscence.
- Optimal Solution: An end ileostomy:
- Provides a safe and effective diversion of fecal flow.
- Allows stabilization of the patient’s condition.
- Is the most appropriate choice in this scenario, considering the emergency nature of the procedure.
Why Not the Other Options?
- B. End Colostomy: A permanent stoma formed with the colon, it is irrelevant here because the colon is being removed in the subtotal colectomy.
- C. Loop Ileostomy: A temporary stoma formed with the ileum, typically used to defunction an anastomosis. However, in this case, a permanent solution like an end ileostomy is needed due to the subtotal colectomy.
- D. Loop Colostomy: A temporary stoma formed with the colon, commonly used in diverting cases involving the colon. It is not suitable as the colon is being removed in this procedure.
- E. End Jejunostomy: A permanent stoma formed with the jejunum, generally performed for upper small bowel diseases or obstructions. It is not relevant as the jejunum is not involved.
- F. Loop Jejunostomy: A temporary stoma formed with the jejunum, rarely used and not appropriate here since the jejunum is not part of the surgery.
- G. Caecostomy: A stoma formed with the caecum, usually used for decompression in colonic obstruction. It is not applicable here, as the caecum is removed in a subtotal colectomy.
Summary:
In an emergency subtotal colectomy for uncontrolled ulcerative colitis, an end ileostomy is the safest and most practical choice. It ensures fecal diversion without the risks associated with anastomosis in an unstable setting. Other options are either temporary, inappropriate, or unrelated to the surgical procedure.