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Atlas of Intestinal Stomas
Victor W. Fazio • James M. Church • James S. Wu
Editors
Atlas of Intestinal Stomas
Editors
Victor W. Fazio, A.O., M.B., B.S., M.S.,
F.R.A.C.S., F.R.A.C.S. (Hon), F.A.C.S., F.R.C.S
(E. Hon), F.R.C.S (Ed. Hon), M.D. (Pol. Hon),
F.R.C.S.I. (Hon)
Department of Colorectal Surgery
Digestive Diseases Institute
Cleveland Clinic Lerner College
of Medicine of Case Western
Reserve University
Cleveland Clinic Foundation
Cleveland, OH
USA
faziov@ccf.org
James M. Church, B.Sc. (Hum Bio), M.B. Ch.B.,
M.Med. Sci. (Anatomy), F.R.A.C.S.
Department of Colorectal Surgery
Digestive Disease Institute
Cleveland Clinic Foundation
Cleveland, OH
USA
churchj@ccf.org
James S. Wu, Ph.D., M.D.
Department of Colorectal Surgery
Digestive Disease Institute
Cleveland Clinic Foundation
Cleveland, OH
USA
wuj@ccf.org
ISBN 978-0-387-78850-0 e-ISBN 978-0-387-78851-7
DOI 10.1007/978-0-387-78851-7
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011933843
© Springer Science+Business Media, LLC 2012
All rights reserved. This work may not be translated or copied in whole or in part without the written permission
of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except
for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known
or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed
as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going to press, neither
the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may
be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
This book is dedicated fi rst and foremost to our late mentors,
Dr. Rupert B. Turnbull, Jr., M.D. and Frank L. Weakley, M.D.
And to Dr. Fazio’s grandchildren, Halle, Kisandra, Griffi n, James
Hunter and Talon, to Dr. Church’s grandchildren, James and Olivia;
and to Dr. Wu’s family, Margaret and Michelle.
Fig. 1 Rupert B. Turnbull, Jr.
Fig. 2 Frank L. Weakley
Fig. 3 Norma N. Gill, the fi rst director of the Cleveland
Clinic Foundation School of Enterostomal Therapy
Preface
The fi rst edition of the Atlas of Intestinal Stomas by Rupert B. Turnbull (Fig. 1 ) and Frank L.
Weakley (Fig. 2 ) was published in 1967 specifi cally to provide the practicing intestinal sur-
geon access to the techniques of ostomy construction. The principles leading to methods that
worked were products of centuries-old experiences of surgeons around the world. Many of the
techniques selected for illustration by Turnbull and Weakley are still standard in clinical practice. However, in the 43 years since the publication of the fi rst edition, new procedures and new
techniques have emerged. These advances stimulated us to update the Turnbull/Weakley Atlas
with the Atlas of Intestinal Stomas . Additions include chapters on anatomy and physiology,
biliary stomas, pediatric ostomies, the continent ileostomy, urostomy, laparoscopic stoma construction, stomas in trauma surgery, stomas for antegrade continence enema, percutaneous
ostomies, and quality of life. There are also updated sections on ileostomy, colostomy, enterostomal therapy (Fig. 3 ), and on the management of complications of stomas such as manage-
ment of the high output ostomy, enterocutaneous fi stula, parastomal hernia, prolapse, and skin
conditions. We also have included a chapter on particularly challenging stomas that we hope
will be particularly helpful for surgeons faced with diffi cult circumstances.
This new edition differs from the fi rst in that it is multi-authored. However, each chapter is
written with a clarity and directness that is similar to the original.
The Turnbull/Weakley Atlas was illustrated by a single artist, Robert M. Reed, former
head of the Cleveland Clinic Medical Illustration Department. Atlas of Intestinal Stomas is
illustrated entirely by Joe Pangrace and his staff of the same department. Pangrace, mentored
by Reed early in his career, has developed his own style of illustration that we describe as
accurate, crisp, and beautiful.
Few of the contributing authors to the Atlas of Intestinal Stomas had the privilege of working
closely with our “well diggers,” Drs. Turnbull and Weakley. Those of us who did believe that
they would be pleased with our work.
Victor W. Fazio, M.D.
James M. Church, M.D.
James S. Wu, M.D.
vii
Acknowledgments
The editors acknowledge fi rst the Cleveland Clinic Foundation for its enthusiastic support of this
work. In particular, we acknowledge Ann Paladino, Director of the Cleveland Clinic Center for
Medical Art and Photography and members of her team whose talent, skill, and efforts made this
project possible. We thank Joe Pangrace, CMI; William Garriott; Elizabeth Halasz, CMI; and Wendy
Knapp for their ability to clearly convey, through illustration, the surgical and medical concepts of
this surgical atlas. We extend our appreciation to Kathleen Miller for digitalizing the quality of photographic slides and historical photos. We thank Jeffrey Loerch for processing licenses for hundreds
of Cleveland Clinic illustrations and photographic works. We thank Joyce Balliet of the Department
of Colorectal Surgery for her extensive photographic contributions to the book. We thank Marty
Hodgson of the Department of Colorectal Surgery for her tireless support of this work over many
years. We thank the Staff of the Cleveland Clinic Library for providing superlative access to the
literature. We acknowledge each of the authors to this work who have selfl essly given their knowledge, experience, and time. We thank Mr. Sreejith Viswanathan, Ms. Sajeni Ravindranathadas, and
Ms. Vinitha Vipin our Project Managers at SPi Global for constructing the book. We gratefully
thank our editors at Springer, Maureen Pierce, Paula Callaghan, Andy Kwan, Susan Westendorf, and
Richard Hruska, who, with limitless patience and gentle nudging, guided us from drawing table to
a completed work. Without the contributions of these individuals and their offi ces, this Atlas would
not have been possible.
Fig . 4 Joseph A. Pangrace, CMI
ix