Stomas

Question 1

What is a stoma?

Answer 1

Surgically created opening in the body between the skin and a hollow viscus

Abdominal stomas are mainly used to divert faeces or urine outside the body where it can be collected in a bag at the skin.

Question 2

Name the three common types of stoma

Answer 2

Colostomy
Ileostomy
Urostomy

Question 3

Colostomy

• content
• location
• position

Answer 3

Made using large bowl (or colon)

LIF

content of colostomy bag=solid

Positioned flush

Question 4

Ileostomy

• content
• location
• position

Answer 4

Created using small bowel

RIF

Less water absorbed in small bowel so contents of stoma have liquid consistency

Spout

Question 5

Why is content of colostomy hard stool?

Answer 5

Faeces have had time to travel through the colon undergoing water absorption.

Question 6

Why are colostomies positioned flush to the skin?

Answer 6

Enzymes present in large bowel contents are less alkali and therefore less irritating to the skin.

Question 7

When are permanent end colostomies indicated?

Answer 7

indicated when abdominoperineal resection is done, the cancer is unresectable or the sphincter is damaged beyond repairable

leading to removal of entire column

Question 8

When are temporary end colostomies indicated?

Answer 8

reversible

done to rest the bowel such as in diverticulitis or obstruction.

part of a two-stage Hartmann’s procedure

rectum and bowel will be re-anastomosed at a later date.

Question 9

Why are ileostomies spout?

Answer 9

Enzymes contained in small bowel contents can irritate skin, the bowel has a spout sticking out from the abdominal wall.

This allows faeces to drain without touching the skin.

Question 10

When are permanent ileostomies indicated?

Answer 10

After a panproctocolectomy for ulcerative colitis or familial adenomatous polyposis

Question 11

When are temporary-end ileostomies indicated?

Answer 11

During emergency bowel resection where it is considered unsafe to form an anastomosis with the remaining bowel at that time (e.g. intra-abdominal sepsis or bleeding).

Question 12

When are loop ileostomies indicated?

Answer 12

• when a distal loop of the ileum is brought out to the skin with 2 lumens draining into the stoma bag
• used as a temporary diversion of stool usually to protect a distal anastomosis
• This is to protect such distal anastomoses to reduce the risk of an anastomotic leak from when stool passes through the join of the two ends of the bowel
• Proximal limb is the one that passes out the stool, and the distal limb usually acts as a mucous fistula, draining out the secretions produced within the mucosal lining from the lumen to the caecum.

Question 13

Why would you need to ‘rest an anastomosis’ in an ileostomy?

Answer 13

• patients who are at high risk for anastomotic leak
  
  • eg, malnourished, high-dose steroids, DM
• who have an intestinal anastomosis <5 to 7 cm from the anal verge (low anastomosis below the peritoneal reflection)
• hemodynamically unstable (eg, trauma, sepsis, perforation)

Question 14

Urostomy

• content
• location
• position

Answer 14

created after removal of bladder

RIF

will contain urine

• Drain urine from the ureters to the skin and into the stoma bag
• Connection between the ureters and the skin is called an ‘ileal conduit’ as it is usually made with a piece of ileum.

Question 15

What are some immediate complications of stomas?

Answer 15

GA complications
Necrosis 
Bleeding
Retraction 
Infection
Psychological

Question 16

What are some Early complications of stomas?

Answer 16

Stenosis/ obstruction 
High output – dehydration/electrolyte imbalance
Retraction
Skin irritation
Infection
Psychological

Question 17

What are some late complications of stomas?

Answer 17

Stenosis/ obstruction 
Parastomal hernia 
Retraction 
Prolapse 
Fistula formation 
Skin irritation
Infection
Psychological