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 63-year-old woman presents with large bowel obstruction. On examination, she has a carcinoma located 10 cm from the anal verge.
Answer: D. Loop colostomy
Explanation
Why Loop Colostomy?
- Clinical Context: The patient has a low rectal carcinoma causing a large bowel obstruction.
- Management Principles:
- Large bowel obstruction due to carcinoma should either be resected, stented, or defunctioned.
- Tumors below the peritoneal reflection, like this one, are typically managed with a loop colostomy to defunction the bowel.
- This approach prevents further complications, allows for formal staging, and avoids the risks of an emergency rectal resection.
- Advantages of Loop Colostomy:
- Diverts fecal flow and relieves obstruction.
- Temporary and easier to reverse compared to an end colostomy.
NEXT
Why Not the Other Options?
- A. End Ileostomy: A permanent stoma formed with the ileum, typically used in cases like proctocolectomy. It is inappropriate here as the problem involves the large bowel, and ileal diversion would not relieve the obstruction.
- B. End Colostomy: A permanent stoma formed with the colon, used in cases like abdominoperineal resection where the rectum is permanently removed. This option is not suitable as the obstruction is being managed temporarily, and formal staging is pending.
- C. Loop Ileostomy: A temporary stoma formed with the ileum, used for defunctioning the small bowel or colon in specific cases. However, it is not ideal for defunctioning a low rectal carcinoma, where a loop colostomy is preferred.
- E. End Jejunostomy: A permanent stoma formed with the jejunum, generally used in upper small bowel conditions. It is irrelevant here as the jejunum is not involved.
- F. Loop Jejunostomy: A temporary stoma formed with the jejunum, rarely used and inappropriate in this scenario since the jejunum is not related to the pathology.
- G. Caecostomy: A stoma formed with the caecum, used for decompression in colonic obstruction in specific cases. It is not applicable here as the obstruction is lower in the rectum.
Summary:
For a patient with a low rectal carcinoma causing large bowel obstruction, a loop colostomy is the most appropriate choice. It provides effective defunctioning, prevents complications, and allows for proper staging and planning of definitive treatment. Other options are either permanent, inappropriate, or irrelevant to the surgical situation.