Successful Re-ileostomy Using Skin Flap Formation Techniques

A 61-year-old woman underwent an emergent operation with sigmoid colon cancer resection, colostomy, and ileostomy on colon perforation. The low ileostoma, caused by intra-abdominal bad conditions, had irritated the surrounding skin after surgery, intermittently forcing the patient to fast for a certain period. Six months after the operation, under the judgment that re-ileostomy, essential for hospital discharge, seemed very difficult through another laparotomy, we attempted to make the ileostoma higher not with pulling the ileum from the abdomen but with lowering the surrounding skin using skin flap formation techniques. For re-ileostomy, we cored out the ileostoma to the external oblique muscle, followed by wide skin flap formation. Then, we lowered the peri-stomal skin level with subcutaneous fat resection. Finally, we sutured the skin flap to the ileostoma base. The skin defect area on the side wall of the ileostoma caused surgical site infection but shrank over time, finally leading to the fusion between the ileal mucosa and the ileostoma base skin. The patient has been well without major events, eating a normal diet for eight months after the re-ileostomy. In conclusion, general surgeons should note that this type of stoma re-making is a feasible and minimally invasive alternative to conventional stoma re-making through another laparotomy.