From the Guidelines
In the event of a non-viable colostomy stoma, immediate surgical intervention is required to prevent further complications 1.
Key Considerations
- The patient should be administered broad-spectrum antibiotics to prevent infection, although the specific antibiotic and dosage may vary depending on the individual case and institutional guidelines.
- The stoma should be taken down and the bowel re-anastomosed or a new stoma created, depending on the individual case, ideally within 24-48 hours to minimize morbidity.
- Pre-operatively, the patient should be optimized with fluid resuscitation and bowel preparation, as necessary, to ensure the best possible outcomes.
Management
The management of a non-viable colostomy stoma requires a multidisciplinary approach, involving surgeons, nurses, and other healthcare professionals, to provide optimal care and support to the patient 1.
- Adequate stomal care is crucial to improve clinical outcomes and reduce hospitalizations, and patients with ostomies often face postsurgical complications and challenges to daily self-care 1.
- Clinicians should be aware of the potential complications and challenges associated with ostomies and provide guidance and support to patients beyond the immediate perioperative period.
From the Research
Non-Viable Colostomy Stoma
If a colostomy stoma is non-viable, the following steps can be taken:
- Resection of the non-viable bowel is mandatory, as stated in the study 2
- Primary anastomosis after resection of gangrenous bowel can be a safe surgical treatment option, as reported in the study 3
- The assessment of intestinal viability is crucial in determining the limits of resection, and several techniques have been developed to assess intestinal blood flow at the time of operation, including fluorescein assessment and Doppler studies 4
- Objective and quantitative intraoperative methods of bowel viability assessment are essential in gastrointestinal surgery, and a systematic search of the literature can help evaluate the available methods 5
Assessment of Intestinal Viability
The assessment of intestinal viability can be done using various techniques, including:
- Fluorescein assessment under a modified Wood's lamp as the initial method of evaluating intestinal viability 4
- Doppler ultrasound or perfusion fluorometry for any areas of particularly doubtful viability 4
- Other techniques, such as laser velocimetry, may also be of some value, but their clinical applicability is limited 4
Surgical Treatment
The surgical treatment of a non-viable colostomy stoma involves:
- Resection of the non-viable bowel, as stated in the study 2
- Primary anastomosis after resection of gangrenous bowel, as reported in the study 3
- The choice of surgical treatment depends on the individual case and the surgeon's expertise, and a multidisciplinary approach may be necessary to optimize outcome 6