Stomas

Question 1

What is a stoma?

Answer 1

• Artificial union between a conduit and the outside
  
  • eg colostomy

Question 2

What is a colostomy?

Answer 2

• Colon is brought out onto the skin to divert faeces
• Left iliac fossa
• Spout is not required as faeces is not a skin irritant

Question 3

What are the different types of colostomies?

Answer 3

• End colostomy
• Loop colostomy
• Paul-Mikulicz colostomy

Question 4

Describe the output of colostomies?

Answer 4

• 1-2 formed motions/day
• Into an adherent plastic pouch

Question 5

Describe a loop colostomy?

Answer 5

• Loop of sigmoid colon is diverted out and divided
  
  • The distal end passes mucus
  • The proximal end passes stool
• Usually required due to diseased anorectum

Question 6

Describe an end colostomy?

Answer 6

• Bowel is divided and the proximal end brought out as a stoma
• Hartmann’s procedure and Abdominoperineal resection of rectal cancer

Question 7

Define a Paul-Mikulicz colostomy?

Answer 7

• Double barrelled colostomy where the colon is divided completely
• Each end is exteriorized as two seperate stomas

Question 8

Describe Ileostomies?

Answer 8

• Right iliac fossa
• Frequent fluid motions containing active enzymes
  
  • Spout is formed to prevent fluid contact with skin
• Types:
  
  • Loop/defunctioning ileostomy
  • End ileostomy
• Formation of ileal pouch-anal anastomosis can allow for stoma reversal

Question 9

Describe End ileostomy formation?

Answer 9

Formed when the whole colon and rectum is removed

Question 10

Describe Loop/defunctioning ileostomy formation?

Answer 10

• Disease process prevents re-anastomosis
• Temporary measure to reduce leaks from newly formed anastomoses

Question 11

Name 2 alternative non-stoma forming surgeries?

Answer 11

• Low anterior resection
• Transanal endoscopic microsurgery

Question 12

Describe Low/ultralow anterior resection?

Answer 12

• Part of the rectum is excised and the proximal colon anastomosed to the top of the anal cancer
  
  • The lower the anastomosis, the higher risk of complication

Question 13

Describe Transanal endoscopic microsurgery?

Answer 13

Excision of tumours within the rectum with preservation of the sphincter function

Question 14

What are Urostomies?

Answer 14

• Fashioned after total cystectomy
• Brings urine from ureters to the abdominal wall via an ileal conduit

Question 15

Name things that should be avoided when choosing a stoma site?

Answer 15

• Bony prominences
• The umbilicus and waistline
• Old wounds/scars

Question 16

Describe the use and site of a Gastrostomy?

Answer 16

• Gastric decompression or fixation
• Feeding
• Located at the epigastrium

Question 17

Describe a Percutaneous jejunostomy?

Answer 17

• For feeding purposes in the proximal bowel
• Usually located in the left upper quadrant

Question 18

Name some early complications of stomas?

Answer 18

• Haemorrhage at stoma site
• Stoma ischaemia (dusky grey -> bloack)
• Obstruction secondary to adhesions

Question 19

Name some delayed complications of stomas?

Answer 19

• Dermatitis around stoma site
• Stoma prolapse
• Stoma intussusception

Question 20

Complications of stomas?

Answer 20

• Formation of abdominal wall defect
  
  • Stomal and parastomal herniae
• Necrosis
• Retraction
• Prolapse