Colostomy Creation & Reversal

Procedure Snapshot

• Indication: Diversion after distal obstruction, trauma, or Hartmann’s procedure.
• Expected duration: ___
• Special instruments: Stoma trephine, circular stapler, protector ring, rods.

Step Workflow

Creation

1. Choose site (pre-op marking, infraumbilical).
2. Circular incision through skin/subcutaneous tissue.
3. Open fascia; deliver colon segment.
4. Mature stoma (evert mucosa, suture to skin).

Reversal

1. Elliptical incision around stoma.
2. Mobilize colon, re-enter peritoneum.
3. Create end-to-end or stapled anastomosis.
4. Close fascia and skin ± drain.

Key Pimp Questions

• Q: Commonest site for end colostomy? LLQ (sigmoid).
• Q: Major complication after closure? Leak ___ (PMID 23932216).
• Q: Typical interval before reversal? 8–12 weeks.

Critical Anatomy

• Landmarks: Rectus sheath, epigastric vessels, mesocolon.
• Danger zones: Inferior epigastric arteries, ureter.

Informed Consent Highlights

• Risks:
  • Leak ___ (PMID 23932216)
  • Wound infection ___
  • Parastomal hernia ___ (PMID 30308340)

Post-op Considerations

• Check stoma perfusion.
• Gradual diet.
• Ostomy nurse teaching.

References

• Chassin’s, Colorectal section.
• Clinical Scenarios, Stoma chapter.
• Park 2019 (PMID 30308340).