A loop colostomy is usually indicated for decompression after intestinal obstruction or as a protective colostomy for a more distal anastomosis. It is usually sited in the right transverse colon, preferably to the right of the middle colic artery.
The abdominal cavity is opened and the selected portion of transverse colon is drawn through the wound. A small hole is made with artery forceps in a relatively avascular portion of the mesocolon. A colostomy bridge - a rubber, plastic or glass rod - is passed throught the mesenteric window and the loop is brought out. The serosal surfaces of the two limbs are then sutured together for a distance of 3-4 cm. The colostomy is then opened at this point with primary mucocutaneous suture.
The stoma should be 4-5 cm long and placed mainly over the afferent loop. A soft, wide-bore suction catheter may help to deflate an obstructed colon.
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