Stomas Flashcards
What is a stoma?
- Artificial union between a conduit and the outside
- eg colostomy
What is a colostomy?
- Colon is brought out onto the skin to divert faeces
- Left iliac fossa
- Spout is not required as faeces is not a skin irritant
What are the different types of colostomies?
- End colostomy
- Loop colostomy
- Paul-Mikulicz colostomy
Describe the output of colostomies?
- 1-2 formed motions/day
- Into an adherent plastic pouch
Describe a loop colostomy?
- 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
Describe an end colostomy?
- Bowel is divided and the proximal end brought out as a stoma
- Hartmann’s procedure and Abdominoperineal resection of rectal cancer
Define a Paul-Mikulicz colostomy?
- Double barrelled colostomy where the colon is divided completely
- Each end is exteriorized as two seperate stomas
Describe Ileostomies?
- 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
Describe End ileostomy formation?
Formed when the whole colon and rectum is removed
Describe Loop/defunctioning ileostomy formation?
- Disease process prevents re-anastomosis
- Temporary measure to reduce leaks from newly formed anastomoses
Name 2 alternative non-stoma forming surgeries?
- Low anterior resection
- Transanal endoscopic microsurgery
Describe Low/ultralow anterior resection?
- 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
Describe Transanal endoscopic microsurgery?
Excision of tumours within the rectum with preservation of the sphincter function
What are Urostomies?
- Fashioned after total cystectomy
- Brings urine from ureters to the abdominal wall via an ileal conduit
Name things that should be avoided when choosing a stoma site?
- Bony prominences
- The umbilicus and waistline
- Old wounds/scars
Describe the use and site of a Gastrostomy?
- Gastric decompression or fixation
- Feeding
- Located at the epigastrium
Describe a Percutaneous jejunostomy?
- For feeding purposes in the proximal bowel
- Usually located in the left upper quadrant
Name some early complications of stomas?
- Haemorrhage at stoma site
- Stoma ischaemia (dusky grey -> bloack)
- Obstruction secondary to adhesions
Name some delayed complications of stomas?
- Dermatitis around stoma site
- Stoma prolapse
- Stoma intussusception
Complications of stomas?
- Formation of abdominal wall defect
- Stomal and parastomal herniae
- Necrosis
- Retraction
- Prolapse
