Stoma: an artificial opening of an internal organ on the surface of the body created surgically, (artificial

enterocutaneous fistula between 2 epithelial surfaces), such as ileostomy, colostomy

-

What we are concerned about here are ileostomies and colostomies

- They can be temporary or permanent
- Types of stomas:
1) End stoma: A stoma is created from one end of the bowel. The other portion of
the bowel is either removed or sewn shut (one opening).
2) Loop stoma: A loop of the bowel is pulled out onto the abdomen and held in place with
an external device. The bowel is then sutured to the abdomen and two openings are
created in the one stoma i.e sutured from one side open from the other(Two openings).
3) Double barrel stoma: The bowel is severed and both ends are brought out onto the
abdomen. Only the proximal stoma is functioning. (Two openings)

Site
Content
Color
Shape

Output
Special complications

Ileostomy
Usually RIF (small bowel)
Small bowel content (succus
entericus)
Red/grayish
Spouted (small bowel has high
enzyme content so spouted
shape will prevent irritation to
surrounding skin)
Continuous output >500cc
(more than colostomy)
Skin irritation, electrolyte
disturbances (especially
vitamin b12 deficiency),
dehydration, renal failure

Colostomy
Usually LIF (Large Bowel)
Stool
Pink
Flush/flat with skin

Intermittent output (less than

ileostomy)
Increase of gas content,
mucus discharge from rectum
or build up of mucus inside
rectum

Indications of Stoma:
- Input: Feeding
- Output:
Colostomies:
- Mainly for Decompression (colonic obstruction by tumor, complicated diverticular disease
(stricture or abscess), or trauma of the distal colon with perforation and fecal spillage.
-other causes include: 1) protection of a low colorectal or coloanal anastomosis 2) rectovaginal
fistula 3) incontinence.
Ileostomies:
-Mainly for small bowel or proximal colon resection (integrity of a primary anastomosis would
be compromised)
-Other causes include: 1) hemorrhage 2) ischemia 3) perforation 4) sepsis

Complications of stoma:
- Early: Ischemia to stoma
Retraction of stoma leads to leakage
- Late: Bleeding / Leakage / obstruction (by stricture, stool or stenosis) / skin irritation or
infection / bowel prolapsed / parastomal hernia

Drains: what is written is what is important for our OSCE.

Types of drains:
-

Open: 1) gauze (4*4) 2) Penrose 3) Corrugate

Close: 1) passive: rely on gravity 2) active: Redivac (under ve pressure) / underwater seal
(chest tube)

If you saw a drain on a patient you describe:

-

Type
Site
Content (sero anginouse / bile / blood stained)
Amount (its labeled, and to be even more precise remove content from drain and measure
it on an accurate labeled bottle)
If its obstructed or dislocated

Complications:
-

Infection
Pain or discomfort
Ineffective (obstruction, kinked or manufacture defect)
Premature dislocation / Removal
Erosion into blood vessel or a hollow viscus
Wound dehiscence (wound rupture)