Stomas
Definition
Stoma: surgically created opening on the abdominal surface that connects an internal organ (usually bowel or urinary tract) to the outside for waste elimination.
Ostomy: refers to the surgical procedure of creating a stoma
Stoma Classification
There are 2 main ways to classify stomas.
End vs loop stoma (by function):
| Feature | End Stoma | Loop Stoma |
|---|---|---|
| Duration | Often permanent, sometimes temporary | Usually temporary |
| Function | Diverts stool from the distal bowel | Proximal end: diverts intestinal content away from the distal bowel
Distal end: allows mucus and secretions produced by the distal bowel to be discharged |
| Appearance | Single lumen visible | Two lumens visible |
Colostomy vs ileostomy (by anatomy):
| Feature | Colostomy | Ileostomy |
|---|---|---|
| Origin | Colon | Ileum |
| Location | Often left or right lower abdomen (depends on which colonic segment is used) | Usually right lower quadrant |
| Stool consistency | Well-formed stool | Liquid to semi-liquid stool |
| Appearance | Not spouted (no or little protrusion above the skin) | Spouted (obvious protrusion above the skin) (to protect the skin from corrosive, enzyme-rich intestinal content) |
Complications
Early Complications
- Skin irritation – common
- Prevention: use skin barriers and dry the skin well before applying a new bag
- High-output stoma (daily output >1.5 L)
- Can cause electrolyte imbalance, hypovolemia, AKI
- Management: IV fluids and electrolyte correction, consider anti-diarrhoea medications
- Stoma necrosis
- Serious complication that requires potential stoma revision
Late Complications
- Stoma retraction (the stoma retracts, such that it is below the skin level → skin irritation and poor stoma fit)
- Stoma prolapse (bowel protrudes through the stoma opening, may cause bowel ischaemia)
- Parastomal hernia