Intestinal stomas

Intestinal stoma (basic)

Mohammed T. Doukhi

MD,

Technology Jordan university of Science &

INTESTINAL STOMAS

Definition

Classification

Complication of intestinal stoma

Dietary advice to stomatised patient

DEFINITION

Intestinal stomas are,

Iatroginic Surgically created opening of small or

large intestine on to the anterior abdominal wall.

classification

Intestinal stoma

colostomy ileostomy

classification

Intestinal stoma

END STOMAConsists of a single

intestinal lumen

LOOP STOMA Give access to both

afferent & efferent limbs

classification

INTESTINAL STOMA

PERMANEN

T

TEMPORAR

Y

End vs. loop

End ileostomy

In right iliac fossa • Usually a permanent

stoma

End ileostomy

Usually temporary in the emergency setting

►Subtotal colectomy with end ileostomy- in

fulminant or perforated ulcerative colitis. in

distal obstruction of large bowel where

caecum is non viable or perforated.

►After a segmental resection of small bowel

where primary anastomosis is unsafe. e.g.

perforated Crohn’s disease, thromboembolic

bowel ischamia

End ileostomy

In temporary end ileostomy: Distal bowel

closed & left in abdomen exteriorized as a

mucous

fistula

End ileostomy

In temporary end ileostomy: Relaparotomy to

restore intestinal continuity when the patient

has recovered (after 3-4 months).

Loop ileostomy

Most common in terminal ileum, transverse

colon & sigmoid colon. • A loop of bowel is

brought to the anterior abdominal wall & held

in place by a plastic bridge passed through the

mesentery. • Bowel wall is incised & edges are

sutured to skin. • Plastic bridge is removed

when mucocutaneous anastomosis has

matured (after 5-7 days)

Loop ileostomy

Loop ileostomy

Loop ileostomy

In general, temporary stomas. • Can be

reversed via the stoma site 2-3 months after

formation

Comlication of itestinal stoma

Early

1. high output

2. Ischaemia

3. Retraction

Late

1. Stenosis

2. Prolapse

3. Parastomal herniation

4. Obstruction of small bowel

5. Haemorrhage

6. Diversion colitis

7. Dermatitis

8. Psychological

High output.; Output from the newly

constructed ileostomy is usually high (1–1.5 L)

in the first 2 weeks. The average daily output

from an established ileostomy is 500–800

mL/day. A high-output ileostomy is one that has

an effluent discharge of more than 1 L/day.

Patients with an ileostomy are prone to high-

output diarrhoea, with resultant water and

sodium depletion.

cont,

Ischemia

Retraction

Complete retraction into

peritoneal cavity Peritonitis

Partial retraction

Subcutaneous tissue is

exposed to faecal contents

Peristomal cellulitis,

abscesses & fistulae

Stenosis

Predisposing causes:

►Aponeurotic opening too

small ►Stomal ischaemia

Prolapse

Stomal prolapse

Predisposing factors:

►Aponeurotic opening too

large ►Excessive

mobilization of redundant

bowel ►Raised intra-

abdominal pressure

Parastomal herniation

Parastomal herniation The

most common late

complication . Occurs in up

to 30% of stomas.

Incidence increases with

time

Dermatitis

Contact dermatitis from

occlusive appliances

Allergic responses to

adhesives Fungal &

bacterial infections

Dietary advice to ostomates

• Take low fibre food to reduce bulk in stool &

help prevent intestinal obstruction. • Avoid

vegetables known to result in offensive odour.

×Raddish ×Cabbage ×Garlic ×Cucumber

To reduce flatus, avoid:

× carbonated beverages

× chewing gum

× smoking

• Chew food well

• Drink adequate amounts of water

How to apply stoma

Cont,