[What patient needs which stoma?].

Abstract

Patients with small bowel obstruction hardly ever need a stoma. Advanced peritoneal carcinomatosis (mostly due to colorectal or ovarial cancer) may require a proximal palliative fecal diversion. Likewise stomatas for colonic ileus became less frequent. The type of the stoma and its necessity depend on the patient's condition, on the duration and the cause of the obstruction, i.e. on the condition and the damage of the bowel. Terminal sigmoidostomy has its place mainly as a part of the Hartmann's procedure treating sigmoid diverticulitis with inflammatory pseudotumor, with free perforation and diffuse peritonitis. For oncological reasons Hartmann's resection should not be performed for rectal cancer--except for very old patients in bad condition. Colonic ileus due to colorectal cancer can usually be treated by resection and primary anastomosis. In case of delayed ileus it may be better to resect the proximal colon and to perform an ileocolostomy to avoid complications. Risky anastomoses due to damaged bowel or for patients in bad condition may be protected by a loop-ileostomy or a loop transverse colostomy. They are both easy to perform and to close with very few complications. Summarizing we may conclude that very few patients really need a stoma today--patients showing special risks such as diffuse peritonitis, absceding inflammation or damaged bowel as a result of delayed ileus.