INTESTINAL STOMAS

An intestinal stoma is an opening of the intestinal and urinary tract onto the abdominal wall, constructed surgically or appearing inadvertently.

TYPES OF STOMA -colostomy -ileostomy -jejunostomy -urinaty conduit

COLOSTOMY

Colostomy is an artificial opening made in the large bowel to divert faeces and flatus to the exterior, where it can be collected in an external appliance.

TYPES

ACCORDING TO THE ANATOMIC LOCATION

-sigmoid colostomy

-end descending colostomy

-transverse colostomy

-cecostomy

ACCORDING TO FUNCTION

-decompressing colostomy: to provide decompression of large intestin_ -diverting colostomy: to provide diversion of faeces.

DECOMPRESSING COLOSTOMY

INDICATION

Treatment of obstructing cancer of the rectum, or sigmoid colon, ftequently discovered on an emergency basis with no oppurtynity for prepration of intestine.

DISADVANTAGE

Does not necessarily provide complete faecal diversion; carries risks of potentially fatal sepses if there is disruption of intestinal continuity distal to stoma.

TYPES OF DECOMPRESSING STOMAS

-blow hole- decompressing stoma constructed in caecum or transverse colon

-tube type of cecostomy -loop transverse colostomy

DIVERTING COLOSTOMY

Provides complete dviresion of intestinal content

INDICATION

-After removal of rectum blc of cancer ( APR) or rarely blc of inflammatory bowel disise limited to rectum or anus

-when there is breach of distal bowel continuitv.as in:

- traumatic injury; diverticulitis; perforated unresectable Ca; leake(

or threatened anastomosis.

-To allow external radiation of an unresectable rectal Ca subsequentaly to be followed by an attempt at a definitive Ca operation and possibly a take down of the colostomy

destruction of distal rectum or anus as a result of trauma, cronh's disease, hidradenitis, multiple sphincteric injury.

LOOP TRANSVERSE COLOSTOMY

Serves as a diverting stoma for 6 weeks or until the posterior wall recesses far enough below the wall of abdomen that the loop can enter the distal loop

SITE ')

Through the rectus muscle on right or left side of midline

CONSTRUCTION

CLOSURE

-After stoma is mature ie after the colostomy has been established for 2 months

-healing or surgical cure of distal lesion for which the temp. stoma was made.

-perform a contrast examination ie distalloopograrn, to check there is no distal obstruction or continuity problem at the site of previous surgery.

-distal integrity or adequacy of sphincter muscle function must be carefully evaluated befpre closure of stoma: formal manometric and EMG studies. Or giving the patient a 500 inl enema and asking the patient to hold it until he can comfortably walk to the toilet and expel the enema.

END COLOSOMY

CONSTRUCTION: ?

COMPLICATIONS OF COLOSTOMIES

-Prolapse

-retraction

-necrosis of distal end

-stenosis of the orifice

.;colostomy hernia

-bleeding ( usually from the granulation around the margin of colostomy) -colostomy diarrhea.

ILEOSTOMY

An ileostomy is an opening constructed b/w the small intestine and abdominal wall usually by using distal ileum but sometimes more proximal small intestine.

TYPES

-End ileostomy

-Loop ileostomy

- Loop End ileostomy

-Continent ileostomy: Kock pouch

-Urinary conduit

END ILEOSTOMY

Constructed in patient who require removal of the entire colon and usually the rectum, for infl. Bowel disease or ulcerative colitis .

LOOP ILEOSTOMY

To have complete diversion of the intestinal flow while the pouches are allowed to heel and adept after restorative proctocolectomy for ulcerative colitis and

familial polyposis: .

LOOP END COLOSTOMY

Constructed in rare circumstances in which- it is unsafe to resect the mesentry of distal ileum

-thickened mesentry or a very obese pt with multiple surgical procedures that altered IIiesentry, tension is created on the mesentry as the ileum is broughr to the abdominal wall for construction of ileostomy

CONTINENT ILEOSTOMY ( KOCK POUCH )­

Alternative to conventional ileostomy for selected pt with U C or familial polyposis

ADVANTAGES

-need not wear an appliance

-continent in blw intubations

-no stomal complication

-better quality of life

DISADVANT AGES

-not all pt are continent

-can be difficulty in intubation

-surgery prolonged and carries a risk of complication

URINARY CONDUIT

Constructed of a segment of intestine with well maintained vascularity so that it can be connected to the urinary tract to allow egress of urine through the abdominal wall via a stoma constructed exactly like an ileostomy.

INDICATION

-After cystectomy for invasive Ca of bladder

-management of severe obstructive uropathy

-congenital abnormalities os spina bifida, meningomyelocele, bladder extrophy, trauma to spinal cord resulting in severe neurogenic bladder

COMPLICATION

-Leeking appliance blc of improper placement or construction of.. . ....

. -Stone formation with crystal formation around the stoma itself ( lack of adequate personal hygine and acidification of urine )