Table Of Contents
Stoma
A stoma is an opening from a hollow viscus connecting it to the skin surface.
“Stoma” = opening.
“Ostomy” = surgical creation of an artificial opening.
Ostomy is performed when it is unwise to restore/maintain the continuity of intestines.
Definition of terms
| Term | Definition |
|---|---|
| Stoma | Opening from a hollow viscus connecting it to the skin surface |
| -ostomy | Surgical creation of an artificial opening |
| Gastrostomy | External opening into the stomach. Maintained by inserting a tube |
| Ileostomy | External opening in the small intestine |
| Colostomy | External opening in the large intestine |
| Urostomy | External opening in the urinary tract |
Colosomy vs Ileostomy
| Ileostomy | Colostomy | |
|---|---|---|
| Site | Right iliac fossa | Left iliac fossa |
| Appearance | Spouted | Flushed |
| Effleunt | Liquid | Solid |
| Common complications | Fluid and electrolyte imbalance, excoriation | |
| Bag change | Drainable bags changed every 48 hours | Changed 2 – 3 times a day |
- Site for stoma
- If not marked pre-operatively by a stoma therapist mark with indelible pen
- Avoid bony areas, creases and previous scars
- Should be visible to the patient and on a flat surface
- If there is a panus the stoma is sited above it
- Position the stoma within a triangle formed by the anterior superior iliac line (ASIS), umbilicus and the pubic symphysis in the right iliac fossa (ileostomy) or left iliac fossa (colostomy)
- At least 5 cm from incision sites (far from midline incision in ex-lap), bony prominences (iliac crest, ASIS and costal margin), natural scars (the umbilicus), body folds and belt-line
- Ideally the stoma should be brough out through the fibres of the rectus abdominis to reduce the risk fo parastomal hernia
- Either side of the midline (but preferrably on the right)
- Types of stomas according to duration
- Permanent stoma
- Temporary stoma
- Types of stomas according to structure
- Jejunostomy
- Ileostomy
- Cecostomy
- Colostomy
- Urostomy
- Classification of stomas
- End ileostomy or urostomy: spouted (to reduce irritation), red-pink, velvety surface, mucosal folds visible
- End colostomy: flushed, pale-pink, smooth surface, few mucosal folds
- Loop ileostomy: mucosal bridge (efferent loop inactive, afferent loop activ is spouted)
- Loop colostomy: mucosal bridge
- Barrel stoma: no mucosal bridge
- Indications for temporary stomas
- Inability to swallow post CVA (gastrostomy)
- High risk of anastomotic leakage
- Severe malnutrition
- Hemodynamic instability
- Peritonitis
- Fecal peritonitis (loop colostomy)
- Penetrating injury to the rectum and colon (end colostomy)
- Rectovaginal fistula (loop colostomy)
- Fecal incontinence
- Complex Perianal fistulas
- Sigmoid colectomy for complications of carcinoma or diverticulitis (Hartmann’s procedure, end colostomy)
- Indications for permanent stomas
- Permanent loss of swallowing e.g. multiple sclerosis, motor neuron disease (gastrostomy)
- Total abdominal proctocolectomy for severe IBD (end ileostomy)
- Abdominal-perineal resection (APR) for anorectal cancer or low rectal carcinoma (end colostomy)
- Advanced obstructive rectal tumors (end colostomy)
- End stoma
- Bowel is completely divided
- Proximal end sutured to abdominal wall. Distal end stumped, left in abdomen or removed.
- Proximal end → drains feces
- Loop stoma
- Bowel is partially divided
- Both openings sutured to abdominal wall
- Proximal end → drains feces
- Distal end → drains mucus
- Double barrel
- Bowel is completely divided
- Both ends are sutured to the abdomen
- Complications of stomas
- Stoma necrosis
- Significant stomal bleeding
- Retraction
- Stenosis
- Parastomal hernia
- Prolapse
- Parastomal skin dermatitis
