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
15. Loop colostomy
• Can be done using transverse or descending
colon.
• Can serve as long term stoma.
16.
17.
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.
39. Stoma bags
• Closed end bags
• Open end bags
• One piece system
• Two piece system
40.
41. Closure of stoma
• Important to decide when to close.
1. Distal integrity
2. Adequacy of sphincter
3. Primary cause
42.
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
