Creation of a neoabdominal wall to facilitate emergency placement of a terminal ileostomy in a morbidly obese patient

Morbid obesity of the abdominal area creates difficulty with creation of a Brooke ileostomy because of thickened, foreshortened mesentery of the terminal ileum, limitation to mobilization, and thickness of the abdominal wall through which the terminal ileum must be placed in the stoma, causing undue tension on the vasculature with a higher frequency of retraction and necrosis. Such a problem may be ameliorated by performing a subcutaneous lipectomy about the stoma and creating a thinned neoabdominal wall to facilitate the creation of a temporary Brooke stoma. Despite initial difficulty with stoma appliances, this operative technique in selected obese patients outweighs the limited complications that may be encountered.