The role of intestinal stoma in patients with spinal cord injury.

In the long term following spinal cord injury, bowel dysfunction causes major physical and psychological problems. A retrospective review of intestinal stomas performed in patients with spinal cord injury over a 10 year period was performed to investigate their role in alleviating these problems. Twelve patients underwent left iliac fossa end colostomy and two patients right iliac fossa end ileostomy. The mean age of patients at operation was 54.8 years (20-65), and the mean time from injury to stoma formation was 15 years (2-37). The mean period of unsatisfactory bowel management before stoma formation was 5.4 years (1.5-2.5). Following colostomy the mean time spent on bowel care per week fell from 8.8 h (0.6-12.2) to 1.4 h (0.3-3.5) and independence in bowel care rose from 50 to 92%. All patients stated that their bowel care was easier and 83% said their independence had increased. Ninety-two per cent wished colostomy had been offered earlier and no patient undergoing colostomy wanted it reversed. The most common complication following colostomy was exclusion colitis. The mean time of follow-up post colostomy formation was 38 months (7-130). Formation of an intestinal stoma is a safe, effective and well accepted treatment for selected patients with intractable problems of bowel management following spinal cord injury.