Colostomy Indications: Surgical Diversion for Colorectal Pathology

A colostomy creates a stoma (colon brought to abdominal wall) to divert fecal flow. Indications span emergency and elective settings.

Common Indications

1. Obstruction: Malignancy, stricture, volvulus, intussusception.
2. Trauma: Penetrating/blunt injury, iatrogenic perforation.
3. Inflammatory Bowel Disease: Crohn's colitis, severe ulcerative colitis (toxic megacolon, refractory).
4. Diverticulitis: Complicated (perforation, abscess, fistula) – Hartmann's procedure.
5. Colorectal Cancer: Low rectal cancer (abdominoperineal resection), palliative diversion for obstruction.
6. Anorectal Malformations: Imperforate anus, cloaca (neonatal).
7. Radiation Proctitis: Refractory bleeding/stenosis.
8. Fistulas: Rectovaginal, rectovesical, perianal (Crohn's).
9. Perforation: Ischemic colitis, stercoral ulcer, endoscopic.

Types

• End colostomy: Proximal end brought out; distal closed/rectal stump (Hartmann's).
• Loop colostomy: Loop exteriorized; temporary diversion (reversible).
• Double-barrel: Both ends exteriorized.

Decision Factors

• Patient physiology, disease stage, reversibility potential, functional outcome, quality of life.
• Multidisciplinary: colorectal surgeon, stoma nurse, oncologist, gastroenterologist.