stoma

• stoma - artificial opening of a hollow organ
• the bowel or urinary system is artificially opened onto the surface of the abdomen, allowing faeces of urine to drain, bypassing the distal portions of the bowel or urinary tract

  a specially adapted bag (stoma bag) is fitted around the stoma to collect the waste product and is emptied as required
• colostomy - the large intestine is brought onto the skin
• colostomies drain more solid stools, as much of the water is reabsorbed in the remaining large intestine

  they can be flatter to the skin (compared with ileostomies which have a spout), as the solid contents are less irritating to the surrounding skin

  they are typically located in the left iliac fossa
• an ileostomy - end portion of the small bowel is brought onto the skin
• ileostomies drain more liquid stools as the fluid content is normally reabsorbed later in the large intestine

  they have a spout which allows them to drain directly into a tightly fitting stoma bag without the contents coming into contact with the surrounding skin

  they are typically located in the right iliac fossa
• gastrostomy - create an artificial connection between the stomach and the abdominal wall

  this can be used for providing feeds directly into the stomach in patients that cannot meet their nutritional needs by mouth
• percutaneous endoscopic gastrostomy (PEG) - when the gastrostomy is fitted by an endoscopy procedure
• urostomy - create an opening from the urinary system onto the skin

  they have a spout and are typically located in the right iliac fossa
• all patients with stomas should have training on how to manage the stoma and have regular follow-up with a specialist stoma nurse
• end colostomy is created after the removal of a section of bowel where the end part of the proximal portion of the bowel is brought onto the skin

  faeces are able to drain out of the end colostomy into a stoma bag

  the other end of the remaining bowel (distal part) is sutured and left in the abdomen

  it may be reversed at a later date where the two ends are sutured together creating an anastomosis
• end colostomies are permanent after a panproctocolectomy (total colectomy with removal of the large bowel, rectum and anus)

  an alteranative to this is to create an ileoanal anastomosis J-pouch

  this is where the ileum is folded back on itself and fashioned into a larger pouch that functions like a rectum

  the j-pouch is then attached to the anus and collects stools prior to the person passing a motion
• a loop colostomy or loop ileostomy is a temporary stoma used to allow a distal portion of the bowel and anastomosis to heal after surgery

  they may be called a covering or defunctioning loops colostomy or ileostomy as they allow faeces to bypass the distal healing portion of the bowel until healed and ready to restart normal function

  they are usually reversed around 6-8 weeks later

  the bowel is partially opened and folded so that there are two openings on the skin side by side, attached in the middle
• “Loop” (colostomy) refers to it being the two ends (proximal and distal) of a section of small bowel being brought out onto the skin. The proximal end (the productive side) is turned inside out to form a spout to protect the surrounding skin. This distal end is flatter. This allows you to distinguish between the proximal and distal portions of the bowel.
• urostomy - used to drain urine from the kidney, bypassing the ureters, bladder and urethra

  may be used after a cystectomy (removal of bladder)
• urostomy - creating an ileal conduit. A section of the ileum (15 – 20cm) is removed and end-to-end anastomosis is created so that the bowel is continuous. The ends of the ureters are anastomosed to the separated section of the ileum. The end of the section is brought out onto the skin as a stoma and drains urine directly from the ureters into a urostomy bag.
• Urostomy bags need to fit tightly around the urostomy to avoid urine coming in contact with the skin. Urine in contact with the skin will cause irritation and skin damage
• Stomas have a number of possible complications:

  • Psycho-social impact
  • Local skin irritation
  • Parastomal hernia
  • Loss of bowel length leading to high output, dehydration and malnutrition
  • Constipation (colostomies)
  • Stenosis
  • Obstruction
  • Retraction (sinking into the skin)
  • Prolapse (telescoping of bowel through hernia site)
  • Bleeding
  • Granulomas causing raised red lumps around the stoma