intestinal stomas

1. Intestinal Stomas
Dr Manoj kumar

2. Introduction
• Stoma is an opening of intestinal tract onto
abdominal wall.
• Can be temporary or permanent

3. Selection of stoma site
• The location must be carefully selected
preoperatively.
• It should avoid any deep folds of fat, scars, and
bony prominences of the abdominal wall.
• The site is chosen by evaluating the patient in
the standing, sitting, and supine positions.

4. • Right lower quadrant for ileostomy and
• Left lower quadrant for colostomy is ideal.

5. Colostomy
• The most common indication for fashioning a
colostomy is cancer of the rectum.
• Other indications are distal colorectal
anastomosis and perforations

6. Types
• By duration
1. Temporary
2. Permanent

7. • By anatomic location
▫ End sigmoid
▫ End descending
▫ Transverse colon
▫ Cecostomy

8. • By type of function
▫ To provide decompression of the large
intestine
▫ To provide diversion of the feces.

9. Decompressing colostomy
• Bridge to definitive operation.
• May not provide complete diversion.
• Types :
1. Blow-hole
2. Tube cecostomy
3. Loop colotomy

10. Blow-hole colostomy
• Rarely done.
• Reserved in critically ill patients.
• Small incision.
• Temperory.

13. Tube cecostomy
• Similar to blow hole.
• Less prolapse, but usually blocked with feces.

15. Loop colostomy
• Can be done using transverse or descending
colon.
• Can serve as long term stoma.

18. • If this stoma is properly constructed, the
posterior wall will bulge upward, providing the
desired diversion as well as decompression.
• If there is a possibility that the colostomy may
become permanent, it may be advantageous to
divide the colon with a stapler and create a
“divided end-loop” stoma

19. Diversion colostomy
• It is performed when
1. The distal segment of bowel has been completely
resected.
2. Perforation or obstruction of the distal bowel
3. Destruction or infection of the distal colon,
rectum, or anus (eg, Crohn’s disease or failed
anal sphincter reconstruction).

20. • Only made by complete transection of colon.
• A well constructed loop colostomy may serve as
diverting colostomy.
• The distal limb may be closed or brought out to
make mucous fistula depending upon the
underlying condition.

21. Irrigation
• Can be done in properly constructed and well
functioning colostomy.
• Improved quality of life.
• Poor results in some patients.

22. Ileostomy
• Construction should be more precise than for a
colostomy.
• Can be temporary or permanent.
1. End ileostomy
2. Loop ileostomy
3. Loop end ileostomy
4. Continent ileostomy

23. End ileostomy
• Mostly permanent.
• Done in ulcerative colitis, familial polyposis.
• Loop ileostomy becoming more common.

24. • Distal end of ileum is preferred.

27. Loop ileostomy
• Mostly temporary
• Serves both diversion and decompression
• For complete diversion divided end loop method
is used.

29. Continent ileostomy
• Or kock pouch
• In selected patients with ulcerative colitis and
familial polyposis
• Ileal pouch anal anastomosis

30. 1. Creation of pouch
2. Creation of nipple valve
3. Suspension of pouch
4. Creation of stoma

35. Stomal necrosis

36. Retraction

37. Prolapse

38. Parastomal hernia

39. Stoma bags
• Closed end bags
• Open end bags
• One piece system
• Two piece system

41. Closure of stoma
• Important to decide when to close.
1. Distal integrity
2. Adequacy of sphincter
3. Primary cause

43. Diet for stoma patients
• 1 to 6 weeks after ileostomy: restriction of high
fiber diet is recommended.
• Start diet containing fiber after 6weeks one or
other according to bowel habits.

44. • Ileostomy patients should take more fluids
• Around 3-4L
• Signs of dehydration
▫ feeling dizzy or lightheaded
▫ feeling thirsty
▫ having dry mouth, tongue and skin
▫ urine is dark
▫ feeling restless or agitated

49. Appendicular stoma
• Mitrofanoff appendico vesicostomy
• Malone antegrade enema

50. Thank you