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Key Points

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  1. Intestinal stomas in infancy and childhood can be life-saving or can greatly improve the quality of life.

  2. There are a variety of indications for both acute and chronic intestinal conditions.

  3. Positioning the stoma on the abdominal wall away from bony prominences or skin depressions is important for excellent ostomy bag seal.

  4. The varieties of stoma configurations (end stoma, loop stoma, end-to-side, double barreled) all have specific indications and potential complications.

  5. Stoma closure is a major surgical procedure with potentially serious complications if not performed well.

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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.

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Indications

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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.

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Table Graphic Jump Location
Table 47-1   Stoma Indications 
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Techniques

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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.

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Figure 47-1

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.

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Figure 47-2

An end ostomy is created by exteriorizing the proximal ...

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