GASTRO-INTESTINAL
SURGICAL STOMAS
Brief anatomy
Definition
• Artificial opening(mouth-like) to the exterior
of the abdomen so as to drain content from
the tubular structures inside e.g. bowel,
ureter.
• It is done for diversion of urine, fecal matter in
case of malignancy, trauma, sepsis or after
surgery.
Types of Stomas
• Ileostomy-terminal 5cm ileum is projected out on
skin of abdominal wall to bypass the entire large
intestine and to drain semi-liquid fecal matter.
Placed in the right iliac fossa lateral to right rectus
muscle.
• Colostomy-colon at different levels is brought out
on skin to divert fecal matter.
• Ileal urinary conduit- segment of isolated ileum
used to drain urine from ureters. Ureters are
anastomosed to a closed ileal conduit.
Cont…
• Vesicostomy- it is found in children. The
anterior wall of the bladder is brought out and
the bladder mucosa sutured to the skin of the
abdominal wall.
• Cutaneus ureterostomy-
Types of colostomy
I. End colostomy-damaged section of bowel is
removed and working end is brought through the
abdomen to the skin surface e.g. Hartmann’s
procedure which involves sigmoidectomy, end
colostomy and closure of rectal stump.
Cont..
ii. Loop colostomy-loop of the bowel is brought
through the abdomen to the skin surface and
temporarily supported by a plastic bridge or rod.
The rod keeps loop from slipping back into
abdominal cavity e.g. transverse loop colostomy
which is created to relieve intestinal obstruction or
perforation.
It is typically temporary.
Cont..
iii. Double-barrel colostomy-two separate
stomas are created and both ends are
brought through the abdomen to the skin
surface as two separate sections.
Proximal stoma diverts feces to abdominal
wall whereas the distal stoma expels mucus
from distal colon
may be temporary or permanent.
Indications of colostomy
Temporary
Congenital megacolon, anorectal malformation,
sigmoid volvulus, high anal fistula, trauma to
left-sided growth, perforation to left sided
colon, intestinal obstruction.
Permanent
Abdominal-perineal resection, carcinoma of anal
canal, after Hartmann’s operation.
Types of colostomy closure
Usually takes place 3 months after temporary
colostomy.
a. Extra peritoneal-was done in loop colostomy
by pacing spur between and closing the
antimesenteric part of colon.
It prevents peritoneal contamination but due
to inadequate closure, it may cause stool
leakage and adhesions.
Cont….
b. Intraperitoneal closure-method used
currently.
Types of ileostomy
Loop ileostomy
Brooke’s classic end non-continent ileostomy
Koch’s continent ileostomy-internal pouch is created from the
distal segment of ileum which serves as a reservoir for stool.
Patient an insert a catheter to drain the contents . Maybe an
option for patients who do not wish to wear an external
pouch over stoma. Has many complications.
Indications of ileostomy
• After total proctocolestomy for ulcerative
colitis, total colonic Hirshsprung’s disease,
Crohn’s disease and total colostomy for
carcinoma.
Complications of stomas
Skin excoriation
Mucosal prolapse
Stenosis
Infection
Diarrhea due to irritation
Bleeding from stoma edge
Herniation of abdominal contents into stoma
leakage
Causes of skin excoriation
Leakage due to improper appliances
Wet skin before placing appliance
Allergy
Infection
Overfilled, kinked or air in the stoma bag
Improper and inadequate adhesive sheet
usage.
Treat skin excoriation
• Zinc oxide cream
• Change type of appliance
• Antibiotics
Patient care
Drink plenty of water
Foods rich in fibre
Avoid anti-depressants and anti-cholinergic
because they cause constipation
Patients can have normal sexual activity.
Stoma appliances
Devices used to collect and dispose effluent
materials which come out of the stoma
IDEAL:
o Leak proof
o Prevent odor
o Available
o Not damage stoma and surrounding skin.
Types of stoma appliances
I. Closed type- discarded when full and is used in
patients with well-formed stool.
II. Drainage type- used in patients with loose liquid
stool. May be emptied and reused.
III. One-piece stoma appliance- bag with stoma system
attached which adheres to skin around stoma.
IV. Two-piece appliance-has a flange with adhesion
system and a bag over it which can be removed and
replaced with a new bag without disturbing bag
underneath.
Cont…