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Abdominal stomas

  • A stoma is a surgically created communication between a hollow viscus and the skin

  • Includes a colostomy, ileostomy, urostomy, caecostomy, jejunostomy and gastrostomy

  • Functionally they can be end, loop or continent stoma

A transverse loop colostomy

Positioning

  • Away from umbilicus, scars, costal margin and anterior superior iliac spine

  • Ensure compatible with the clothing worn by the patient

  • Ideally should be marked preoperatively by stoma nurse

Complications

Structural complications

  • Necrosis

  • Detachment

  • Recession

  • Stenosis

  • Prolapse

  • Ulceration

  • Parastomal herniation

  • Fistula formation

necrotic loop colostomy retracted end colostomy

Pictures provided by Mr Richard Morgan, Freemantle Hospital, Western Australia

prolapse left iliac fossa end colostomy

Picture provided by Vikram Kate, Jawaharial Institute for Postgraduate Medical Education and Research, Pondicherry, India

parastomal hernia

Picture provided by Derek Chen, Perth Australia

Functional disorders

  • Excess action

    • Distal colostomy should produce solid faeces

    • Ileostomy will produce 500-700 ml/day of liquid effluent

    • If excess output consider

    • Inflammatory bowel disease

    • Para-intestinal sepsis

    • Subacute obstruction

  • Reduced action

    • Consider simple constipation or obstruction

Bibliography

Israelsson L A.  Preventing and treating parastomal hernia.  World J Surg 2005;  29:  1086-1089
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