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Content provided by Jon Lund
Clinical Associate Professor, School of Graduate Entry Medicine & Health, University of Nottingham 		 
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Stomas Stomas / Stomata

1. Introduction

An abdominal stoma (mouth in greek) is usually constructed to divert the flow of faeces or urine because of pathology in the gastrointestinal or urinary tract respectively. It is estimated that about 100,000 people in the UK have a stoma and about two-thirds are permanent. The incidence of stomas is declining because of new surgical techniques allowing even ultra low resections to be anastomosed.

2. Types of stoma

  • A. Gastrostomy
  • B. Jejunostomy
  • C. Ileostomy - End ileostomy usually in RIF and spouting to prevent skin excoriation by small bowel contents. Formed when colon has been removed - Loop ileostomy in RIF, Often to defuntion a low rectal anastamosis after anterior resection
    End ileostomy and 2 piece stoma appliance
  • D. Caecostomy
  • E. Colostomy:
    • End Colostomy - In LIF
    • Loop Colostomy - usually in LIF or upper abdomen
    • Mucous Fistula - Rarely seen, bottom of a laparotomy woung where the proximal end of the rectal stump has been brought to the surface to to prevent blow out
    End colostomy just after formation at operation for very low rectal cancer. End colostomy just after formation at operation for very low rectal cancer.

3. Indications

  • A. Feeding: via gastrostomy or jenunostomy avoid the need for a nasogastric tube. Commonly used following upper GI surgery, in patients with CNS disease( e.g. CVA).
  • B. Decompression: colostomy or ileostomy are routinely fashioned to decompress the bowel in patients who are clinically obstructed because of malignancy when resection not indicated.
  • C. Diversion: Loop ileostomy to protect a distal anastomosis or in case of low intestinal fistula, loop colostomy in advanced rectal cancer or prior to chemoradiotherapy to prevent obstruction, colostomy divert the faecal stream in patients with anal Crohn's or other perineal disease.
  • D. Exteriorisation: end ileostomy after panproctocolectomy for UC, end colostomy after abdominoperineal resection for low rectal cancer, end colostomy and mucous fistula following resection (the distal/efferent segment is brought out to prevent "blow-out" and only produces mucous, hence mucous fistula).

4. Complications/General Problems

  • A. Technical problems:
    • Ischaemia/Gangrene(usually due to tension and inadequate length)
    • Prolapse (Common with transverse loop colostomies)
    • Stenosis
    • Parastomal Hernia large parastomal hernia complicating colostomy
  • B. General Problems High Output. This is usually a problem for ileostomies. More than 1lt of high enzyme content can be lost from a high output ileostomy. Gallstones and vitamin B deficiency in patients with ileostomy due to disruption of the enterohepatic circulation
  • C. Practical and social issues:
    • Odour
    • Leakage
    • Flatus
    • Sexual

5. Podcasts

Stoma Discussion
A podcast with Sister Liz Evans, Stoma Care Specialist, and Jon Lund. Best listened to with headphones.
Length: 13 mins     Filesize: 65Mb

Play (streaming)         (Download flv)
Stoma Tools
A podcast with Sister Liz Evans, Stoma Care Specialist, and Jon Lund. Best listened to with headphones.
Length: 6 mins     Filesize: 30Mb

Play (streaming)         (Download flv)
Stoma Siting
A podcast with Sister Liz Evans, Stoma Care Specialist, and Jon Lund. Best listened to with headphones.
Length: 10 mins     Filesize: 50Mb

Play (streaming)         (Download flv)