Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXX: Reoperative Abdominal Surgery
United States Department of Defense
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Reoperation may become necessary in the early postoperative period because of retraction or necrosis of a colostomy or ileostomy. If the bowel has been exteriorized under tension, retraction may result. Tension becomes a problem when the bowel is not adequately mobilized by liberal incision in the lateral peritoneal reflections of the colon. The foregoing is especially applicable to fixed segments of the bowel, such as flexures and the descending colon. Failure to suture the mesenteric segment securely to the peritoneum also may contribute to retraction. Correction of this complication requires reoperation to perform the mobilization of the colon that should have been performed at initial operation. Construction of another stoma in more proximal bowel or within the retracted segment under no tension is then possible. If easy deliverance of the bowel to the abdominal wall is not possible even after such mobilization due to inflammatory shortening of the mesentery, performance of a more proximal colostomy in a mobile portion of bowel and resection of the bowel between the retracted colon and the new stoma must be carried out. In the case of ileostomy, immediate maturation of the stoma by eversion and mucosa-to-skin suture with fine absorbable suture prevents problems. In addition, mesentery-to-peritoneum suture is as necessary here as it is in the colon. If retraction of a ileostomy does occur, laparotomy is necessary to construct a new stoma in fresh bowel slightly more proximal to the original stoma.
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