Stomas

Question 1

What is an ileostomy?

Answer 1

Formed from any part of the mid or distal small bowel. May be loop (often to rest the distal bowel) or end (usually as a result of surgical removal of distal bowel

Question 2

What is a colostomy?

Answer 2

Formed from any part of the large bowel. May be loop (to rest distally) or end (due to surgical resection)

Question 3

What is a urostomy?

Answer 3

Ureters are ‘plumbed’ into the proximal vascularised isolated loop of ileum. The distal end is brought out as a stoma.

Question 4

What is a gastrostomy?

Answer 4

Either surgically created or endoscopically formed connection between anterior stomach and anterior abdominal wall. Often for stomach drainage or direct feeding

Question 5

What is a jejunostomy?

Answer 5

Either surgically or endoscopically created connection between the proximal jejunum and anterior abdominal wall. It is often used for direct feeding

Question 6

What features of a stoma might suggest that it is a ileostomy?

Answer 6

These are ususally spouted, have prominent mucosal folds, tend to be dark pink/red in colour, and are most common on the right side fot he abdomen

Question 7

What features of a stoma would suggest that it is a colostomy?

Answer 7

Usually flush, have flat mucosal folds, tend to be light pink in colour, and are most common in the left side of the abdomen

Question 8

What features of a stoma suggest that is a urostomy?

Answer 8

Usually spouted, have prominent mucosal folds, tend to be dark pink/red in colour, and are most common in the right side of the abdomen.

These are indistinguishable from ileostomies unless output can be seen - urine

Question 9

What are features of a stoma which suggest that it is a gastrostomy or a jejunostomy?

Answer 9

Narrow calibre, flush with little visible mucosa, most common in upper left quardrant. They are usually fitted with indwelling tubes or access devices

Question 10

Why is an ileostomy made into a spout?

Answer 10

The small bowel produces digestive enzymes which if spilled onto the skin will result in excoriation

Question 11

What are complications of ileostomies/colostomies?

Answer 11

• Poor function
• Poor placement - Leakage and excoriation, Loss of patient’s feeling of security
• Prolapse
• Parastomal hernia - Poor bag adherence, Leakage and excoriation, Loss of patient’s feeling of security
• Stenosis
• Fistula formation

Question 12

What are categories of poor function of a stoma?

Answer 12

• Non-passage of GI content
• Overactivity

Question 13

Why might stomas not pass GI contents?

Answer 13

Technical problems

• Tight trephine e.g. opening through abdominal wall too narrow
• Twisting of intestine as it enters thro abdominal wall

Non-technical problems

• Paralytic ileus
• Post-operative adhesions

Question 14

What is meant by the term overactive stoma?

Answer 14

This refers to the passage of excess fluid through the stoma (usually an ileostomy). This fluid appears ‘watery’ with little normal gastrointestinal content i.e. very pale green in colour indicating the presence of very little bile.

Question 15

What can cause stoma overactivity?

Answer 15

Sub-acute obstruction

• Tight trephine resulting in stomal narrowing
• Post-operative adhesions
• Intermittent twisting of stoma

Intra-abdominal sepsis

Question 16

What are complications of parastomal hernias?

Answer 16

• Inability of bag to remain adherent
• Leakage and excoriation
• Intestinal obstruction

Question 17

How might you manage a parastomal hernia?

Answer 17

• Local repair
• Resiting of stoma
  
  • Moved to opposite side
  • Involves laparotomy
  • Complex surgery

Question 18

Why can stenosis occur at stoma sites?

Answer 18

• Ischaemia of the distal end of the intestine used for the stoma
• Recurrence of Crohn’s disease in the stoma

Question 19

How might you manage a stenotic stoma?

Answer 19

• Dilatation using Hegar’s dilators
• Local refashioning
• Resiting

Question 20

What might excoriation around a stoma sight indicate?

Answer 20

This suggests small bowel enzymes digesting the skin and this can lead to poor adherence of the stoma bag

Question 21

Why can fistulas occur in ileostomies?

Answer 21

• Improper placing of the mucocutaneous suture (too deep)
• Recurrence of Crohn’s disease

Question 22

What are loop ileostomies and loop colostomies used for?

Answer 22

To divert enteric and faecal content away from:

• Distal anastomosis
• Obstructed distal bowel
• Distal tumour (e.g. sigmoid carcinoma)

Question 23

When are end colostomies used in an elective setting?

Answer 23

• After APER (Abdomino-perineal resection of rectum)
• As part of Hartmann’s procedure
  
  • Locally advanced rectal cancer
  • Anastomosis deemed to be dangerous

Question 24

When are end colostomies used in an emergency setting?

Answer 24

• Peritonitis
• Perforated diverticular disease
• Obstructed distal colon
• Patient is unstable

Question 25

When are urostomies indicated for?

Answer 25

Carcinoma of the bladder