intestinal stomas,types and focused in complication

1. Intestinal stoma (basic)
Mohammed T. Doukhi
MD,
TechnologyJordan university of Science &

2. INTESTINAL STOMAS
Definition
Classification
Complication of intestinal stoma
Dietary advice to stomatised patient

3. DEFINITION
Intestinal stomas are,
Iatroginic Surgically created opening of small or
large intestine on to the anterior abdominal wall.

4. classification
Intestinal stoma
colostomy ileostomy

5. classification
Intestinal stoma
END STOMA
Consists of a single
intestinal lumen
LOOP STOMA
Give access to both
afferent & efferent limbs

6. classification
INTESTINAL STOMA
PERMANEN
T
TEMPORAR
Y

7. End vs. loop

8. End ileostomy
In right iliac fossa • Usually a permanent
stoma

9. End ileostomy
Usually temporary in the emergency setting
►Subtotal colectomy with end ileostomy- in
fulminant or perforated ulcerative colitis. in
distal obstruction of large bowel where
caecum is non viable or perforated.
►After a segmental resection of small bowel
where primary anastomosis is unsafe. e.g.
perforated Crohn’s disease, thromboembolic
bowel ischamia

10. End ileostomy
In temporary end ileostomy: Distal bowel
closed & left in abdomen exteriorized as a
mucous
fistula

11. End ileostomy
In temporary end ileostomy: Relaparotomy to
restore intestinal continuity when the patient
has recovered (after 3-4 months).

12. Loop ileostomy
Most common in terminal ileum, transverse
colon & sigmoid colon. • A loop of bowel is
brought to the anterior abdominal wall & held
in place by a plastic bridge passed through the
mesentery. • Bowel wall is incised & edges are
sutured to skin. • Plastic bridge is removed
when mucocutaneous anastomosis has
matured (after 5-7 days)

13. Loop ileostomy

14. Loop ileostomy

15. Loop ileostomy
In general, temporary stomas. • Can be
reversed via the stoma site 2-3 months after
formation

16. Comlication of itestinal stoma
Early
1. high output
2. Ischaemia
3. Retraction
Late
1. Stenosis
2. Prolapse
3. Parastomal herniation
4. Obstruction of small bowel
5. Haemorrhage
6. Diversion colitis
7. Dermatitis
8. Psychological

17. High output.; Output from the newly
constructed ileostomy is usually high (1–1.5 L)
in the first 2 weeks. The average daily output
from an established ileostomy is 500–800
mL/day. A high-output ileostomy is one that has
an effluent discharge of more than 1 L/day.
Patients with an ileostomy are prone to high-
output diarrhoea, with resultant water and
sodium depletion.

18. cont,
Ischemia

19. Retraction
Complete retraction into
peritoneal cavity Peritonitis
Partial retraction
Subcutaneous tissue is
exposed to faecal contents
Peristomal cellulitis,
abscesses & fistulae

20. Stenosis
Predisposing causes:
►Aponeurotic opening too
small ►Stomal ischaemia

21. Prolapse
Stomal prolapse
Predisposing factors:
►Aponeurotic opening too
large ►Excessive
mobilization of redundant
bowel ►Raised intra-
abdominal pressure

22. Parastomal herniation
Parastomal herniation The
most common late
complication . Occurs in up
to 30% of stomas.
Incidence increases with
time

23. Dermatitis
Contact dermatitis from
occlusive appliances
Allergic responses to
adhesives Fungal &
bacterial infections

24. Dietary advice to ostomates
• Take low fibre food to reduce bulk in stool &
help prevent intestinal obstruction. • Avoid
vegetables known to result in offensive odour.
×Raddish ×Cabbage ×Garlic ×Cucumber

25. To reduce flatus, avoid:
× carbonated beverages
× chewing gum
× smoking
• Chew food well
• Drink adequate amounts of water

26. How to apply stoma

27. Cont,