Stomas And Urostomas

Question 0

Main reason for colostomy without bowel obstruction?

Answer 0

Abdominoperineal resection (with imperforate anus)
A low rectal lesion with permanent colostomy as too low for anastomosis

Question 1

Examination of a stoma

Answer 1

Where? Colostomy usually left iliac fossa; ileostomy usually right iliac fossa
Is there a spout (ileostomy) or is it flush (colostomy)?
Is it producing solid faeces (colostomy), liquid faeces (ileostomy), urine (ileal conduit) or just mucus (mucous fistula)?
Is there one opening (most stomas) or two (loop stomas)
“Site, spout, what comes out”

Question 2

Why is rectal surgery so difficult?

Answer 2

Hard to mobilise

Easy to damage the pre sacral plexus -> autonomic dysfunction! decreased sexual function

Question 3

Hartmann’s original procedure

Answer 3

Mucus fistula of rectum, a double barrelled stoma with two separate tubes

Question 4

Modified Hartmann’s Procedure

Answer 4

Primary resection with delayed anastomosis
Excise lesion,create colostomy and leave over-sewn rectal stump
Mainly used for carcinoma with acute obstruction
Occasionally for diverticular disease with perforation or diverticular abscess
Option of restorative anastomosis at a later stage

Question 5

Ddx for calcified mass on abdominal Xray

Answer 5

Calcified faeces
Bladder stone
Prostate
Fibroid

Question 6

Fistula definition

Answer 6

Abnormal connection between two epithelial membranes

Question 7

Loop ileostomy

Answer 7

Increasingly used in colorectal surgery to protect distal anastomosis from rupturing at suture sites
Eg used to protect a sigmoid colectomy or an anterior resection
Typically reserved after 6 weeks
Has largely replaced loop transverse colostomy as easier to create and reverse

Question 8

Complications of stomas

Answer 8

Fluid loss (esp ileostomy)
Odour
Ulceration of skin (esp ileostomy)
Leakage
Stenosis
Prolapse
Retraction
Herniation (parasomal hernia)
Ischemia
Terminal ileum loss - failure to absorb bile salts or Vit B12
Sexual and psychological problems

Question 9

Ileal Conduit (urostomy)

Answer 9

Usually due to invasive bladder ca
Ureters are too fine to be brought directly onto body surface and urine is toxic to skin
Length of ileum (the conduit) is isolated, but left on its vascular pedicle
Anastomosis of the two remaining ends of ileum from which the conduit has been detached
The ureters are implanted into the ileal reservoir, after removal of the bladder
Distal end of conduit brought out as an ileostomy (with typical spout, inverted end)
Catheter left in situ post op to reduce incidence of stricture

Question 10

Hyperchloraemic acidosis with urostomy

Answer 10

Can sometimes happen as the bowel mucosa has an ion pump. The ileum can reabsorb urinary chloride and loses bicarbonate in exchange. This leads to metabolic acidosis.

More common when ureters were transplanted into the sigmoid colon as a false bladder and urine was in contact with the bowel for some time

Question 11

Definition of stoma

Answer 11

Opening of any part of the gut out to the surface