When Is It Necessary to Create a New Stoma from the Small Intestine?

Colostomy

My mother-in-law has had a colostomy for over seven years.
Recently, the stoma became inflamed and retracted.
The doctor mentioned that a new stoma needs to be created in the small intestine.
Under what circumstances is it necessary to create a stoma in the small intestine?

jyd, 40~49 year old female. Ask Date: 2006/03/28

Dr. Li Junde reply Surgery

Dear Mr.
JYD,
Colostomy is generally performed in cases such as bowel obstruction, colorectal tumor surgery, and when fecal matter cannot be expelled through the rectum.
It can be classified as temporary or permanent.
A temporary colostomy is typically part of a staged colorectal surgery, with the intention of reconnecting the colon later depending on the situation.
The location of the colostomy may vary based on the disease and surgical conditions.
If the colostomy function is poor or there is a sensation of prolapse, it may need to be redone, or if the segment of the colon is no longer suitable for reconnection, an ileostomy or jejunostomy may be necessary.
Since I do not have enough information about your family member's situation, it is best to consult the attending surgeon for a clearer explanation.
Best regards,
Li Jun-De 0517

Reply Date: 2006/03/28

More Info

Creating a new stoma from the small intestine, also known as an ileostomy, may be necessary under several circumstances, particularly when complications arise from an existing colostomy or when the large intestine is not functioning properly. Here are some common scenarios that may necessitate the creation of a new stoma from the small intestine:
1. Colostomy Complications: If the existing colostomy becomes inflamed, infected, or experiences prolapse (where the stoma protrudes excessively), it may require surgical intervention. In your mother-in-law's case, the inflammation and the stoma "falling in" could indicate a significant issue that might not be resolvable without creating a new stoma.

2. Bowel Obstruction: If there is a blockage in the large intestine that cannot be resolved, diverting the stool through a new stoma in the small intestine may be necessary. This is often done to relieve pressure and prevent further complications.

3. Severe Disease: Conditions such as inflammatory bowel disease (IBD), including Crohn's disease or ulcerative colitis, may lead to the need for an ileostomy if the disease severely affects the large intestine. If the colon is diseased or damaged beyond repair, a new stoma may be created from the small intestine to allow for waste elimination.

4. Cancer: In cases where colorectal cancer necessitates the removal of a significant portion of the colon, an ileostomy may be created as part of the surgical treatment plan. This is particularly true if the cancer is located in the lower part of the colon or rectum.

5. Trauma or Injury: If there is significant trauma to the abdomen that affects the large intestine, a new stoma may be created from the small intestine to ensure that waste can still be expelled from the body.

6. Failed Colostomy: If the existing colostomy is not functioning properly due to anatomical changes, scarring, or other complications, a new stoma may be necessary to provide a more effective means of waste elimination.

7. Quality of Life Considerations: Sometimes, the decision to create a new stoma may also be influenced by the patient's quality of life. If the current stoma is causing significant discomfort, social embarrassment, or other issues, a new stoma may be created to improve the patient's overall well-being.

In your mother-in-law's case, it is essential to discuss the specific reasons for the recommendation of a new stoma with her healthcare provider. They can provide insights into the underlying issues that led to this decision and explain the potential benefits and risks associated with the procedure.
It is also important to consider the postoperative care and lifestyle adjustments that may be necessary after the creation of a new stoma. Patients often require education on stoma care, dietary modifications, and how to manage any changes in bowel habits. Support from healthcare professionals, including stoma care nurses, can be invaluable during this transition.

In summary, the creation of a new stoma from the small intestine is typically indicated when there are significant complications with an existing colostomy, severe disease affecting the colon, or other medical conditions that necessitate a change in the way waste is expelled from the body. It is crucial to have open communication with the healthcare team to understand the rationale behind this decision and to ensure the best possible outcomes for your mother-in-law's health and quality of life.

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