Management of rectosigmoid obstructive carcinoma in elderly frail
Colostomy MC indication for fashioning a colostomy : CA rectum. Colostomies are also constructed as treatment for Obstructing lesions of the distal large intestine and for actual or potential perforation. Type by Anatomic Location End-sigmoid colostomy (MC) End-descending colostomy Transverse colostomy Cecostomy Decompressing Colostomy Diveing colostomy Indications Distal obstructive lesions causing massive dilation of the proximal colon without ischaemic necrosis Severe sigmoid diveiculitis with phlegmon Selected patients with toxic mega colon Types of Decompressing stomas Blow-hole Cecostomy Blow-hole transverse colostomy Tube type of Cecostomy Loop-tramsverse colostomy Indications When distal segment of bowel has been completely resected (as during APR) Known or suspected perforation or obstruction of the distal bowel (e.g., Obstructing carcinoma, diveiculitis, leaking anastomosis or trauma) Destruction or infection of the distal colon, rectum, or a us (eg: Crohn's disease or failed anal sphincter reconstruction) Type of Diveing Stomas Loop-tramsverse colostomy Loop sigmoid colostomy Ref: Sabiston 20th edition Pgno : 1326-1330
Colostomy
Abdomino-perineal resection (APR)
Resection & primary anastomosis
Hamann procedure
G.I.T