caecostomy

Last reviewed 01/2018

A caecostomy is an artificial stoma formed between the caecum and the abdominal wall

• can be used effectively to allow colonic irrigation in an unprepared, obstructed colon prior to resection of the obstructing lesion and primary anastomosis
• a caecostomy is not good for decompressing the colon nor protecting an anastomosis (1)

To carry out on-table lavage, a large Foley catheter (26-28F) is inserted via a stab incision in the right iliac fossa. Ideally, this gains access to the caecum by an existing caecostomy or an appendicectomy. The catheter is held in place with a Vicryl purse-string suture. The balloon is the inflated and the caecum is secured to the anterior abdominal wall. 8-10 litres of warm saline is then introduced via the catheter and massaged towards the distal colon proximal to the planned site of resection. The fluid exits via wide-bore scavenger tubing. After resection and anastomosis, the catheter is directed towards the ileum to facilitate decompression.

Reference:

• 1) Down, G.M. and Leaper, D.J. (1994). Abdominal stomas. Surgery, 12:1, 1-7.