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Overview of surgical ostomy for fecal diversion

Todd D Francone, MD, MPH, FACS
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


An ostomy is a purposeful anastomosis between a segment of the gastrointestinal tract and the skin of the anterior abdominal wall [1]. An ostomy can be created virtually anywhere along the gastrointestinal tract. For diversion of the fecal stream, the most common ostomies involve the distal small intestine (eg, ileostomy) and large intestine (ie, colostomy).

Temporary or permanent fecal diversions may be needed to manage a variety of pathologic conditions, including congenital anomalies, colon obstruction, inflammatory bowel disease, traumatic disruption of the intestinal tract, or gastrointestinal malignancy [2]. Overall, the number of fecal diversions appears to be declining.

The principles of ostomy construction for the purpose of fecal diversion, including types, site selection, and creation is reviewed here. The routine care and management of common ostomy complications are reviewed separately. (See "Routine care of patients with an ileostomy or colostomy and management of ostomy complications" and "Parastomal hernia".)


Fecal diversion by the creation of an ostomy, which is a purposeful anastomosis between a segment of the gastrointestinal tract and the skin of the anterior abdominal wall, is indicated when restoration of intestinal continuity is contraindicated, or not immediately feasible given the patient’s clinical condition. As an example, patients who are at high risk for anastomotic leak (eg, malnourished, high dose steroids), who have an intestinal anastomosis <5 to 7 cm from the anal verge (low anastomosis below the peritoneal reflection), or who are hemodynamically unstable (eg, trauma, sepsis) may benefit from a temporary ostomy until continuity of bowel can be restored safely [3,4].

Fecal diversions are commonly classified according to the segment of the bowel used to create the ostomy (eg, sigmoid, colon, ileum) and the manner of surgical construction (eg, loop, end, reservoir).

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Literature review current through: Nov 2017. | This topic last updated: Feb 08, 2017.
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