Introduction

“Stoma” is the Greek for mouth or opening. In anatomy, a stoma is technically any opening of the body (such as the mouth or anus). However, usually in medicine when we refer to stomas we are referring to artificial, surgically created stomas, most commonly of the bowel, and sometimes sometimes involving the urinary system.

  • “Ostomy” is a surgically made opening from the inside of an organ to the outside
  • COLOSTOMY is an artificial opening made in the large bowl to divert feces and flatus to the outside
  • ILEOSTOMY is an opening in the small intestine made that feces bypass the large intestine and the anal canal
  • UROSTOMY is an opening from the bladder or ureter, along an ill conduit (a harvested piece of ileum) to the outside

Ileostomy

  • Used in cases where the large intestine has been rendered incapable of functioning normally
  • Usually it is placed in the right iliac fossa
  • Common conditions include
  1. Crohn`s disease
  2. Ulcerative colitis
  3. Familial adenomatous polyposis
  4. Total colonic hirschsprung disease
  • Ileostomy can be temporary and permanent
  • A spout is usually used and it should cover 4 cm of the skin surfaces to prevent skin damage
  • During the early period there may be a fluid imbalance as the ileum adapts to the loss of the colon an ileostomy flux may occur where the fluid loss can mount to 4-5 liters per day
  • The involvement of an ileostomy care nurse is very important
  • Possible complications include
  1. Prolapse
  2. Retraction
  3. Stenosis
  4. Bleeding
  5. Fistula
  6. Parastomal hernia

Colostomy

  • Can be permanent or temporary
  • Usually placed in the left iliac fossa
  1. Temporary colostomies
  • Loop colostomy is performed by bringing a loop of bowl to the skin surface where it is held in place by a plastic bridge through the mesentery the loop is opened and the edges of the incision are sutured to the skin , the plastic bridge is removed after 7 days when adhesion has formed between the bowl and the abdominal wall , a distal loopogram can performed to check for obstruction
  • Double barreled colostomy in which the two loops are brought up to the skin separately
  1. Permanent colostomy
  • Usually formed after APR for rectal cancer
  • It is an end colostomy as the distal end of the divided loop is brought up to the skin and sutured
  • Complications of colostomy include
  1. Prolapse
  2. Retraction
  3. Necrosis
  4. Fistula
  5. Stenosis
  6. Parastomal hernia
  7. Bleeding
  8. Colostomy diarrhea
  • The colostomy care nurse specialist plays an important role in patient education and care of the stoma
Colostomy

Colostomy

Comparison of colostomy and ileostomy

FeatureIleostomyColostomy
Spoutpresentflush
Effluentliquidsolid
Fluid and electrolyteImbalance more commonLess common
SiteRIFLIF

Urostomy

Most commonly used after cystectomy for bladder cancer. Also occasional required in severe renal disease, or after complications of bowel surgery (e.g. where accidental damage has occurred to the bladder or ureters).

Often the procedure is performed at the same time as resection of bladder cancer.

Usually, an ideal conduit is used. A terminal ileum should not be used, as this is the part that reabsorbs bile salts. The distal ends of the ureters are usually attached individually to the piece of ileum.

Colonisation of the ileum with bacteria is almost universal, and UTIs are common.

Urostomy with ideal conduit

Urostomy with ideal conduit

References

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