Abstract
Fecal diversion is an important tool in the surgical armamentarium. There is much
controversy regarding which clinical scenarios warrant diversion. Throughout this
article, we have analyzed the most recent literature and discussed the most common
applications for the use of a diverting stoma. These include construction of diverting
ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory
bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude
the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy
should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis
and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires
diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular
perforation is safe, and a diverting stoma can be used as a bridge to primary resection
in the setting of an obstructing malignancy.
Keywords
diversion - low colorectal/coloanal anastomosis - Crohn's disease - diverticulitis
