Stoma examination

Question 1

End colostomy features and possible procedure(s)

Answer 1

Left sided
1 lumen
No spout
Hard stool

Procedures: Abdomino-perianal resection (rectal Ca <4-5cm from anal verge) = permanent
or Hartmann’s procedure with rectum rectum oversewn (obstruction/perforation secondary to sigmoid tumour or diverticulitis) = temporary

If still has anus - Hartmann’s
No anus - APR (low rectal tumour)

Question 2

End ileostomy features and possible procedure(s)

Answer 2

Right sided
1 lumen
Spouted
Soft/liquid stool

Procedures:
Panproctocolectomy (eg. UC, FAP) - permenant
Emergency (sub)total colectomy with later IPAA (ileal-pouch anal anastomosis= ileum used to make new rectum) or ileal anal anastomosis (IRA) = temporary, acute severe UC

Question 3

loop ileostomy features and possible procedure(s)

Answer 3

Right sided
2 lumens
Spouted
Soft or liquid stool

usually temporary
Procedures:
To defunction distal bowel -
obstruction (eg. malignancy)
Anus (eg. crohn's)
Newly formed anastomosis - anterior resection of rectal Ca >4-5cm above anal verge

Question 4

Loop colostomy features and possible procedure(s)

Answer 4

Upper abdomen (RUQ or LIF)
2 lumens
Not spouted
Hard stool

Procedures - anterior resection, decompression
Colon Ca eg. if likely to obstruct

Question 5

Urostomy features and possible procedure(s)

Answer 5

Either side (usually right)
1 lumen
Spouted
Urine contents

Procedure - total cystectomy

(ureters attached to resected ileum which is exteriorised = ileal conduit. Bowel continuity maintained by primary anastomosis)

Question 6

Ideal site for stoma

Answer 6

Healthy skin
Away from umbilicus and belt line
Avoiding - scars, bony prominences, skin creases
Easily accessible

Question 7

Stoma complications

Answer 7

Early: haemorrhage, high output (low potassium), abscess, retraction
Late: Parastomal hernia, obstruction, prolapse, psychosexual dysfunction

Question 8

Stoma indications

Answer 8

Exteriorisation - perforated or contaminated bowel eg. hartmanns, permeneant (APR)

Diversion - Protection of distal anastomosis, urinary diversion

Decompression - bypass distal obstruction

Feeding - gastrostomy/jejunostomy

Lavage - appendicostomy