Background: Ostomy is an approved surgical option for management of bowel dysfunction and anatomical bowel anomalies, which may results in peritonitis and sepsis, leading to multi-organ failure.

Aim and Objective: To study the feasibility and outcome of ostomy in cases of acute abdomen.

Materials and Methods: We prospectively analyzed 30 cases of acute abdomen, undergoing intestinal stoma formation, following emergency laparotomies in the department of surgery, DVVPF’S Medical College and Hospital, Ahmednagar, Maharashtra during the study period of January 1, 2014 to March 1, 2017. The clinical diagnosis was supported by X-ray erect abdomen, ultrasonography and Contast-enhanced computed tomography.

Results: The study comprised of 30 patients with the mean age of 58 years, with 26 males and 4 females patients. Out of thirty patients of ostomy recruited for the study, 18(60%) and 12(40%) patients underwent colostomies and ileostomies respectively. Colostomy was performed on 18 patients out of which 4(13%) patients suffered from sigmoid volvulus, 2(7%) patients from rectal perforation, 2(7%) patients from carcinoma rectum, 2(7%) patients with rectosigmoid tumor secondary to ovarian carcinoma, 1(3%) patient with intestinal adhesion, 2(7%) patients with splenic flexure neoplastic mass, and 5(16%) patients with cancer sigmoid colon. Temporary Colostomy was performed in 14(78%) patients and Permanent colostomy in 4(22%) patients. Among colostomy patients, 2(11%) patients died. Cause of death was multiorgan failure. Low Anterior Resection (LAR) with ileostomy was performed in 12(40%) cases of carcinoma rectum. 2(8%) patients of ileostomy had died due to anastomotic leakage.

Conclusion: Ostomy is a salvage procedure in saving life of the acute abdomen patients in an emergency setting. This is the preferred surgical option especially for palliation before neoadjuvant chemotherapy and in high risk patients that are not fit for emergency definitive surgery. Protective stoma effectively decreases the incidence of anastomotic leak, post-operative ileus, wound infection, small bowel obstruction, morbidity, mortality and recurrence in cases of bowel pathology.

Keywords: Carcinoma rectum; Colostomy; Ileostomy; Peritonitis; Sepsis.

1. Shinkawa H, Yasuhara H, Naka S et al Factors affecting the early mortality of patients with nontraumatic colorectal perforation. Surg Today 2003;33:13–17.
2. Ertekin C, İğci A, Taviloğlu K et al Nontraumatik kolon perforasyonları. Ulusal Cerrahi Dergisi 1991;7:185–189.
3. Gainant A (2012) Emergency management of acute colonic cancer obstruction. J Visc Surg 2012;3-10:149(1).
4. DINNICK, T. British Journal of Surgery 1934; 22, 142.
5. T. Hawk, B. Levin, Colorectal cancer prevention, J. Clin. Oncol. 2005 ;23(2): 378-391.
6. Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006;76:579–585
7. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92:1150–1154.
8. van Westreenen HL, Visser A, Tanis PJ, Bemelman WA. Morbidity related to defunctioning ileostomy closure after ileal pouch-anal anastomosis and low colonic anastomosis. Int J Colorectal Dis. 2012; 27:49–54.
9. Chang YJ, Yan DC, Kong MS et al Non-traumatic colon perforation in children: a 10-year review. Pediatr Surg Int 2006; 22:665– 669
10. Kenan Büyükaşık, Bünyamin Gürbulak, Emre Özoran, Yiğit Düzköylü,Esin Kabul Gürbulak, Aziz Arı, Hasan Bektaş. Indian Journal of Surgery, 2016;78(6):471-476.
11. Beirens K, Penninckx F. Procare: defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of Procare. Acta Chir Belg. 2012;112:10–4.
12. Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96:462–472.
13. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.
14. R. Phillips, L.J. Harris, P.J. Maxwell, et al., Anastomotic leak rate after low anterior resection for rectal cancer after chemoradiation therapy, Am. Surg. 2010;76: 869-871.
15. Farth, L. Hulten, Loop ileostomy: a superior diverting stoma in colorectal surgery, World J. Surg. 1984;8: 401-407.
16. Güloğlu R, ArıcıC, Tabak B et al Nontraumatik kolonperforasyonları. Kolon ve Rektum Hastalıkları Dergisi ,1995;5: 148–151.
17. Mesfin yohannes, Muluken Fanta, Tesfahun Molla, Proportion of intestinal obstruction and associated factors among patients with non traumatic acute abdomen admitted to surgical ward in Debre Birhan Referral hospital, North east Ethiopia; American Journal of Biomedical and Life Sciences, 2017;5(3):54-62.
18. Hellinger M D Steinhagen R M Colonic volvulus  New York: Springer; 2009;1: 286–298.
19. Meyer F, Marusch F, Koch A, Meyer L, Führer S, Köckerling F, German Study Group “Colorectal Carcinoma (Primary Tumor)” et al Emergency operation in carcinomas of the left colon: value of Hartmann’s procedure. Tech Coloproctol ,2004;8(1):226–229.
20. Abdelrazeq AS, Scott N, Thorn C et al The impact of spontaneous tumour perforation on outcome following colon cancer surgery. Colorectal Dis,2008; 10:775–780.
21. Hartmann H. Nouveau proceed d'ablation des cancers de la partie terminale de colon pelvien. Trentieme congress de Chirurgie, Strasbourg 1921.
22. R J Whiston, N C Armitage, D Wilcox, and J D Hardcastle, Hartmann’s proce-dure: an appraisal, Journal of the Royal society of Medicine, 1993;86(4):205-208.
23. Desai DC, Brennan EJ, Reilly JF, Smink RD The utility of the Hartmann procedure Am J Surg, 1998; 175:152–154.
24. Ambreen, S. Razaque, S. Gulshan, A. Qureshi, Various complications in ileostomy construction, World Appl. Sci. J. 2007;2(3): 190-193.
25. Kaidar-Person O, Person B, Wexner SD. Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg. 2005;201:759–773.
26. Garcia-Botello SA, Garcia-Armengol J, Garcia-Granero E, Espi A, Juan C, Lopez-Mozos F, et al. A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg. 2004;21:440–446.
27. Prashant Raj Pipariya, Ajay V Menon, Aclinical study of incidence of primary repair vs intestinal stomas during emergency surgeries, their complications and morbidity, Scholars Journal of applied Medical Sciences, 2016;4(12A):4208-4211.
28. Vrakas, M.G. Pramateftakis, D. Kanellos, S. Sapidis, P. Hatzigianni, T. Tsachalis, I. Kanellos, C. Lazaridis, Defunctioning ileostomy closure following low anterior resection by chemotherapy, Tech. Coloproctol. 2010;14(1): 77-78.
29. Coons SJ, Chongpison Y, Wendel CS, Grant M, Krouse RS. Overall quality of life and difficulty paying for ostomy supplies in the VA Ostomy Health-Related Quality of Life Study: An exploratory analysis. Med Care. 2007;45:891–895.
30. Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the ostomate after hospital discharge. J Wound Ostomy Continence Nurs. 2007;34:70–79.

Dr Arvind Kumar Prabhat

Postgraduate Student, Department of General Surgery,

DVVPF’s Medical College and Hospital, Ahmednagar, Maharashtra, India