STOMAS
Dr Fiston Kinyamaniyi
SHO/KIU
2021
• “Ostomy” comes from the Greek
“stoma”(στόμα) meaning “mouth”
• In medicine, stoma/ostomy refers to a
surgically created opening of a hollow organ
on the surface of the body to enable excretion
of waste products
• EX. Enterostomy is a surgically fashioned
intestinal opening.
Purpose
• To reduce pain and discomfort
• Allow systematic defecation
• May help to relieve symptoms of intestinal
disease
Classification of intestinal ostomies
• Intestinal ostomies are
classified according
1. Segment of the intestine
that is brought out to the
surface of the body
(Anatomical):
– Gastrostomy
– Jejunostomy
– Ileostomy
– Colostomy
2. According to the duration
– Temporary
– Permanent
3. Reconstruction
– End
– Loop
– Split ileostomy (Two ends brought to the surface separately with
a skin bridge intervening)
– Double Barrel-Miculikz (Two ends brought to the surface
together where the adjacent serosal surfaces are hitched by
sutures, and adjacent mucosal surfaces are sutured)
– Continent (Kock’s pouch)
4. Function
– Decompression colostomy
– Diversion colostomy
1. Colostomy
• Definition:
– It is an artificial opening made between the large
bowel and skin, to divert faeces and flatus to the
exterior, where it can be collected in an external
aplliance.
– Effluent is usually solid
a. Temporary Colostomy
• Indications:
– Distal Obstruction.
– Defunction a low rectal anastomosis after Anterior
resection of the rectum.
– Following traumatic injury to the rectum or colon.
– During operative treatment of a high fistula in ano
– Fulminant Colitis
– Complicated Diverticular disease.
• Site of the colon used:
– A segment which has a mesentery:
• Transverse colon. (Disease involve Lt. side of the colon)
– Sigmoid colon. (|Disease involve the rectum or
rectosigmoid junction)
• Types of temporary colostomies:
– Loop colostomy:
• Bringing a loop of bowel to the surface where it is held in
place by a plastic or glass rod passed through the
mesentery.
• Firm adhesion of the colostomy takes place after 7 days then
the bridge can be removed.
Closure:
• follows the surgical cure or healing of the distal lesion for
which the temporary stoma was constructed
• Also the stoma should be mature (at least 2 months after
establishment of the colostomy)
– Double Barrelled colostomy:
• The colon is divided so that both ends can be brought
separately to the surface with a skin bridge intervening
Advantage:
• ensures that the distal segment (colon, rectum) is
completely defunctioned (Absolute Rest).
– Hartmann’s Procedure:
• This includes a proximal End Colostomy with a distal
closed colonic segment.
• This procedure can be used when resecting a tumour of
the Lt. site of the colon or in Complicated diverticular
disease
b. Permanent Colostomy
• Indications:
– Rectal carcinoma excision( A- P resection)… End
colostomy
– Inoperable rectal or colonic carcinoma … Loop
colostomy
Complications of Colostomy construction
1. Prolapse.
– it leads to dysfunction, it is not important in temporary colostomy which
sooner or later will be closed, only in permanent cases which will need
refashioning or resiting
2. Retraction.
– due to tension and infection
3. ParaColostomy Hernia.
– especially in end terminal colostomy). Treatment should include resiting
the colostomy and the hernia defect closed.
4. Bleeding.
5. Necrosis and gangrene of the distal end.
– due to loss of viability due to interference with its blood supply, too
much ligation of mesenteric vessels).
6. Stenosis of the colostomy orifice
– occurs at the mucocutaneous junction, due to infection and cellulitis
which is followed by scarring.
– Treatment should include refashioning of colostomy site with excision
of skin disc.
7. PeriColostomy Abscess and Fistula.
– occurs when a misplaced suture that fixes the colon to the deeper
layers of the abdominal wall instead of passing through the serosa,
passes through the whole thickness of the bowel
– The abscess bursts and forms a fistula.
– Treatment should include laying the track open and leaving it to
granulate.
8. Colostomy diarrhea.
2. Ileostomy
• Definition:
– It is an artificial opening made between the ileum
and skin of the abdominal wall, to divert intestinal
contents to the exterior, without a sphincter to
control the timing of its emptying.
– Effluent is usually liquid.
a. End Ileostomy.
• Indications:
– In cases where total proctocolectomy is done.
• Ulcerative colitis.
• Crohn’s disease.
• Familial polyposis Coli
b. Loop Ileostomy.
• Indications:
– as an alternative of a loop colostomy for
Defunctioning (for protection)
• Low rectal anastomosis following a anterior rectal
resection procedure.
• Ileoanal pouch procedure following Total
proctocolectomy.
c. Complications of Ileostomy:
1. Prolapse
2. Retraction
3. ParaIleostomy Hernia
4. Bleeding
5. Necrosis and gangrene of the distal end
6. Stenosis of the Ileotomy orifice
7. Skin reaction around the stoma (Excoriation,
erosion, sloughing)
8. Fluid and electrolyte imbalance (Ileostomy Flux).
Parameters Colostomy Ileostomy
Site Rt. upper abdomen Rt. iliac fossa
Lt. iliac fossa
Discharge Formed faeces or faeculent fluid Fluidy
Color of discharge Brownish or Blackish Brownish, Greenish
Yellowish
Odor of discharge Very offensive Less offensive
(excessive gases)
Stoma Large Small
Constructed flush or slightly elevated from Constructed as a nipple like projection
the skin above the skin
Reaction of the Surrounding skin Usually normal Erythematous, oedematous (from
enzymatic digestion)
• Types of stoma appliances:
– Two piece
• Bag and ring are separate
Advantage:
• less trauma to the stoma from frequent changing.
– One piece
• Bag and ring are matted
Disadvantage:
• higher chance of trauma to the stoma with granulomas and
bleeding, excoriation and ulcerations around the stoma.