What is a Stoma?
A stoma is an artificially created opening from a hollow internal organ (like the intestine or urinary tract) to the surface of the body, usually through the abdominal wall. It allows the elimination of bodily waste when normal passage through the rectum or urethra is not possible.
Common types include:
- Ileostomy: From the small intestine
- Colostomy: From the large intestine
- Urostomy: From the urinary tract (ileal conduit)
- Gastrostomy: Into the stomach for feeding
Types of Stomas
1. End Ileostomy / Urostomy
Origin: Terminal ileum or urinary tract
Appearance: Red-pink spout, velvety surface, mucosal foldsPurpose: Temporary or permanent fecal/urinary diversion
Indications:
- Total colectomy for ulcerative colitis
- After cystectomy (ileal conduit for urine)
2. End Colostomy
Origin: Large intestine
Appearance: Pale pink, low or flush with the skin, smooth surfaceIndications:
- Permanent: after abdominoperineal resection (for rectal carcinoma)
- Temporary: for diverticulitis or colon obstruction (Hartmann’s procedure)
3. Loop Ileostomy
- Two lumens (efferent & afferent loops) joined by a mucosal bridge
- Indications: Diverting stool to protect distal anastomosis
4. Loop Colostomy
- Similar to loop ileostomy but in the large intestine
- Used in emergencies or to divert feces temporarily
How to Identify Different Types of Stomas
| Feature | End Ileostomy/Urostomy | End Colostomy | Loop Ileostomy |
|---|---|---|---|
| Color | Red-pink | Pale pink | Pink-red |
| Surface | Velvety, moist | Smooth | Mixed, mucosal bridge |
| Position | Lower right abdomen | Lower left abdomen | Lower right abdomen |
| Spout | Raised | Flush/flat | Two lumens visible |
Indications for Common Stomas
Ileostomy:
- Ulcerative colitis
- Emergency bowel resection without anastomosis
- Protection of anastomosis
Colostomy:
- Rectal cancer (permanent)
- Complicated diverticulitis or obstruction (temporary)
Urostomy (Ileal conduit):
- Post-cystectomy urinary diversion
Gastrostomy:
- Feeding in patients with CVA, pharyngeal dysfunction, or motor neuron disease
Abdominal and Thoracic Surgical Incisions
Understanding incisions helps anticipate postoperative stoma sites.
Common Anterior Incisions
| Incision Type | Location | Use Case |
|---|---|---|
| Midline (Upper/Lower) | Midline abdomen | Exploratory laparotomy |
| Kocher (Subcostal) | Right upper quadrant | Gallbladder, liver |
| Lanz | Right iliac fossa | Appendectomy |
| Pfannenstiel | Suprapubic | C-sections, pelvic surgery |
| Left Paramedian | Left side of midline | Colostomy, sigmoid resection |
Posterior Incisions
| Incision Type | Location | Use Case |
|---|---|---|
| Posterolateral Thoracotomy | Between ribs | Lung resection |
| Renal (Subcostal) | Flank area | Kidney surgery |
Stoma Appliances and Patient Considerations
Stoma appliances must be:
- Well-fitted to avoid leakage and skin damage
- Easy to handle for patients with limited dexterity or vision
- Positioned away from skin folds and scars
- Customized: one-piece or two-piece systems, with drainable or closed ends
Preoperative planning is critical to successful stoma management and patient satisfaction.
Complications of Stomas
| Complication | Description | Management |
|---|---|---|
| Necrosis | Black/dark purple stoma due to ischemia | Reoperation |
| Stenosis | Narrowing of stoma opening | Dilatation or revision |
| Retraction | Stoma pulled back into abdomen | Revision surgery |
| Prolapse | Stoma telescopes outward | Appliance change or surgical correction |
| Herniation | Bulging around stoma due to bowel herniation | Belt, stoma repair |
| Peristomal Dermatitis | Irritation from leakage or adhesives | Skin care, appliance change |
| High Output Fluid Loss | Common in ileostomies; causes dehydration and electrolyte imbalance | Dietary management, fluid replacement |
Stoma Site Selection and Care
Siting Principles:
- Away from scars and skin creases
- Above or below belt line (not on it)
- Should be visible and accessible to the patient
- Ideally marked preoperatively with the stoma therapist
Routine Care:
- Empty and clean bag regularly
- Monitor skin around stoma
- Change bag as needed (depends on type)
- Watch for signs of infection, leakage, or malfunction
Features of Output from Different Stomas
| Stoma Type | Output Type | Description |
|---|---|---|
| Ileostomy | Liquid to semi-solid | Digestive enzymes present; risk of skin damage |
| Colostomy | Soft to formed stool | Less irritating to skin |
| Urostomy | Clear urine | Risk of infection and stone formation |
Tips to Recognize and Manage Common Stoma Issues
- Spouted vs Flush: Spouted (raised) stomas are usually from ileum/urostomies; flush ones from colon.
- High-output ileostomy: More than 1.5 L/day; risk of dehydration.
- Stoma bleeding: Minor bleeding from mucosa is normal; profuse bleeding is not.
- Gas ballooning: Can be managed by vented pouches or filters.
FAQs on Stomas and Surgical Incisions
Q. What is the difference between an ileostomy and a colostomy?
A. An ileostomy is formed from the small intestine (ileum) and usually has liquid output. A colostomy is formed from the large intestine (colon) and has more formed stool.
Q. Can a stoma be reversed?
A. Yes, temporary stomas like loop ileostomies or colostomies can be reversed if the underlying condition resolves.
Q. How long does a stoma bag last?
A. Typically 3–5 days, but it depends on the appliance, skin type, and stoma output.
Q. Is stoma formation permanent?
A. Not always. Some are permanent (after total colectomy), others are temporary for healing or diversion.
Q. What diet is best for stoma patients?
A. Depends on stoma type. High-output stomas need low-residue diets and fluid balance. Patients should avoid foods causing blockages or excessive gas.
