Stoma

What is stoma?
Type of stoma?
How do we decide for stoma sites?
What is the complications of stoma?
You may find the answer in this slide.

1. Stoma care

2. Introduction Stoma Artificial union made between 2 conduits or Between a conduit and the outside Type of stoma Colostomies Loop colostomy End colostomy Double barreled Ileostomies Urostomies Defunctioning stomas

3. Colostomies Loop colostomy A loop of colon is exteriorized,opened ,and sewn to the skin A rod under the loop prevents retraction (removed after 7days ) Defunctioning stoma Temporary Prone to complications than end colostomy

4. Colostomy End colostomy The bowel is divided  Proximal end brought out as a stoma Distal end may be Resected Closed & left in the abdomen ( Hartman's procedure) Exteriorized (forming mucous fistula)

5. Colostomy Double-barrelled (Paul Mikulicz) colostomy Colon is brought out as double barrelled Closed using an enteretome

6. Ileostomies  Protrude from the skin  Emit fluid motions Contain active enzymes need skins protection Usually following proctocolectomy For ulcerative colitis Loop ileostomies can also be formed

7. Defunctioning stomas Loop colostomy/ileostomy Uses Relieve distal obstruction Protect distal anastomoses Minimise severity of leakage

8. Urostomies  Fashioned after total cystectomy Bring urine from ureters to abdominal wall Via ileal conduit Usually incontinent

9. Alternatives to colostomy Total anorectal reconstruction Posterior sagittal anorectoplasty

10. Complications of stomas Early Haemorrhage at stoma site Stoma ischemia High output (lead to hypokalemia) Obstruction secondary to adhesion Stoma retraction Delayed  Obstruction (fail at operation to close lateral space around stoma) Dermatitis  Stoma prolapse Stoma intussusception Stenosis Parastomal hernia Fistulae Psychological problem

11. Choosing a stoma site Avoid Bony prominences – ASIS,costal margins The umbilicus Old wounds/scars - may be adhesions beneath Skin folds and creases The waistline Assessed pre-op by the stoma nurse Colostomies : left iliac fossa Ileostomy/ileal conduit : right iliac fossa