Intestinal stomas in infancy and childhood can be life-saving or can greatly improve the quality of life.
There are a variety of indications for both acute and chronic intestinal conditions.
Positioning the stoma on the abdominal wall away from bony prominences or skin depressions is important for excellent ostomy bag seal.
The varieties of stoma configurations (end stoma, loop stoma, end-to-side, double barreled) all have specific indications and potential complications.
Stoma closure is a major surgical procedure with potentially serious complications if not performed well.
The exteriorization of the intestine in a child, performed for acute or chronic intestinal conditions, can be lifesaving or can improve the quality of life if well planned and properly performed. Depending on the disorder requiring treatment, the stoma can be fashioned at any level of the gastrointestinal tract and may provide complete diversion (end stoma), partial diversion (loop stoma or vented stomas), or access to the distal bowel (mucous fistula). Each of these variations has specific indications, and knowledge of their proper use and construction is an important part of the pediatric surgeon's armamentarium. This chapter discusses the indications for enterostomas in children, some alternative methods for stoma construction, stomal complications and their management, and stoma closure.
The indications for stomas in children can be conveniently grouped into acute (emergent) or elective and further subdivided by age group and by basic intestinal disorder (congenital or acquired). These are summarized in Table 47-1. Obviously not all of these disorders will invariably require a stoma each time they are encountered, but a stoma can be an important alternative if primary anastomosis is felt to be unwise for a variety of reasons.
The various ostomy configurations are shown in Figs. 47-1 to 47-7. Each kind of ostomy has its specific indications and use, depending on the disease process, age, and body habitus of the patient, anticipated duration of ostomy need, and need for total or partial diversion.
Diagram of a “loop” ostomy. The bowel is left in partial continuity, with a generous opening along the antimesenteric border. In the early postoperative period, a rod or soft rubber tube can be left between the 2 limbs of the bowel to help hold it above skin level.
An end ostomy is created by exteriorizing the proximal ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessSurgery Full Site: One-Year Subscription
Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.
Pay Per View: Timed Access to all of AccessSurgery
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.