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Stoma: Stoma is an artificial opening or mouth like to the exterior, the abdominal wall so as to drain
the content from the tubular structures inside, like bowel or ureter.
It is an one type of artificial fistula.
Types:
-Ileostomy: terminal 5 cm ileum is projected out, on to the skin of abdominal wall.
-Colostomy
-Cutaneous ureterostomy
-Ileal urinary conduit
- Vesicostomy
-Ostomy: Operation that connects the GI tract to abdominal wall skin or the lumen of another hollow organ.
-Stoma: Opening of the ostomy.
-Ileostomy effluent is usually liquid, whereas colostomy effluent is usually solid
-Ileostomy patients are more likely to develop fluid and electrolyte problems
-An ileostomy is usually sited in the right iliac fossa
-End-colostomy is usually sited in the left iliac fossa
Colostomy
Colostomy: A colostomy (or ileostomy) stoma is an artificial opening made in the colon (or small
intestine) to divert faeces and flatus outside the abdomen where they can be collected in an external
appliance.
Types:
According to the period of diversion According to the way of fashioning of colostomy
-Temporary (Usually loop colostomy) -Terminal or end colostomy
-Permanent (Usually end colostomy) -Loop colostomy
-Divines defunctioning colostomy
Permanent colostomy: is always end colostomy placed in left iliac fossa, 6 cm above and medial
to the anterior superior iliac spine.
Terminal or end colostomy: This is done at the sigmoid colon and opening is made at the left
iliac fossa. It is a type of permanent colostomy having a single stoma.
Loop colostomy: Here a loop of colon is taken out and colostomy is performed. It may be in the
sigmoid or transverse colon. It is a temporary colostomy and most commonly practiced.
Indications:
-Congenital:
High anorectal anomalies where the child is born with obstruction.
-Traumatic:
Injuries to the rectum and anal canal (to prevent faecal peritonitis) (. Here sigmoid colostomy is done)
-Inflammatory:
In some complicated cases of fistula in ano
Diverticulitis.
-Neoplastic:
Carcinoma rectum and anal canal(sigmoid colostomy is done)
Carcinoma descending colon (transverse colostomy is done.)
-Miscellaneous:
Colonic obstruction
Rectovesical or rectovaginal fistula.
Complications of colostomy:
-Prolapse of mucosa (prolapse of distal loop mucosa is common)commonest complication
-Skin irritation/excoriation( due to leak adjacent to appliances. Other causes may be Wet skin before
placing the appliance, Infection like of bacteria and candida)
Retraction
-Ischaemia
-Stenosis
-Parastomal hernia
-Bleeding
-Fistulation
Colostomy closure:
-Colostomy closure is most easily and safely accomplished if the stoma is mature, typically after the
colostomy has been established for two months.
-Criteria for temporary colostomy closure:
-Integrity of distal colon should be normal and adequate.
-Anorectal sphincter should be normal.
-Cause for construction of colostomy is cured completely without any suspicious of recurrence of
same disease distally
Types of closure:
-Extraperitoneal
-Intraperitoneal type (Now intraperitoneal closure is done.)
Ileostomy appliances tend to be drainable bags, which are left in place for 48 hours, while
colostomy appliances are simply changed two or three times each day