Stomas

Question 1

What are the different types of stoma?

Answer 1

Ileostomy
Colostomy
Urostomy (ileal conduit)

Caecostomy (rarely done in theory can be done in bowel obstruction with a competent ileocaecal valve to decompress)

Question 2

Describe a further way to categorise stomas?

Answer 2

Loop or End

Loop: no bowel is resected a piece of bowel is brought to the surface and cut halfway through to form 2 lumens.

End: one lumen. Virtually all the bowel distal is resected except for potentially a rectal stump to allow anastomosis at a later date.

Question 3

Describe the method used to create a urostomy?

Answer 3

Usually formed after a bladder resection for malignancy.

A small section of ileum is resected and the remaining ends are anastomosed.

The ureters are sutured into the section of ileum that has been resected.

This section of ileum is brought to the surface to form a stoma.

Question 4

Describe the features which will help you differentiate between the different types of stoma?

Answer 4

Ileostomy: 
RIF (normally)
Spouted
Contents are more liquid 
Bag gets emptied several times a day and changed every few days. 

Colostomy: 
LIF (normally)
Flush with the skin.
Contents are more formed. 
Bags are changed daily not emptied. 

Urostomy:
RIF (normally)
Spouted
Bag contains urine.

Question 5

In which situations would you have a loop ileostomy?

Answer 5

Anterior resection (resection of a rectal cancer with a primary anastomosis) a loop ileostomy will be performed to allow rest to the distal anastomosed bowel.

To allow bowel rest in UC/Crohn’s colitis

Question 6

In which situations would you have an end ileostomy?

Answer 6

Panproctocolectomy (resection of all the colon, rectum and anus)

Pancolectomy (resection of all the colon leaving the anus)

Subtotal colectomy (resection of all the colon leaving some of the rectum and anus)

Indications for these surgeries include:

• Bowel necrosis
• Severe UC
• FAP and related diseases

Question 7

In which situations would you have a loop colostomy?

Answer 7

As a palliative procedure in the case of an obstructing rectal cancer.

To protect a newly formed anastomosis.

Question 8

In which situation would you perform an end colostomy?

Answer 8

Hartmann’s procedure (an emergency bowel resection of the sigmoid colon with a rectal stump and an end colostomy)
-Performed in perforation in Crohns, diverticular disease, volvulus)

Abdomino-peroneal resection (low rectal or anal tumour, so peroneum is resected also)

In patients with incontinence that has not been helped by medical management.

In patients with rectal prolapse that has reoccurred after normal prolapse surgery.