An intestinal stoma is an artificial opening in the abdominal wall that connects the intestinal tract to the outside of the body. There are different types of stomas including ileostomies, colostomies, and urostomies. Ileostomies divert small intestine contents and have a liquid effluent that is discharged continuously. Colostomies divert large intestine contents and have solid, intermittent effluent. Stomas can be temporary or permanent depending on the clinical situation and are constructed in different ways including as an end stoma or loop stoma. Proper stoma care and use of appliances is important for managing stomas.

1. Definition
Greek: ‘mouth’
Stoma = an artificial opening in the abdominal wall, which
connects a hollow viscus(bowel, urinary tract) to the outside
environment/ to divert faeces or urine to the exterior which is
collected in an external appliance.
Natural openings: Nostrils, mouth, anus.
Intestinal stoma = opening of the intestinal tract onto
abdominal wall
Viscus: large interior organ in any of the great body cavities, e
specially those in the abdomen.
STOMA

2. Types of stoma
•Duration (Temporary or Permanent )
•Anatomical location:
•CNS: ventriculostomy
•Respiratory: tracheostomy
•GIT: ileostomy, colostomy
•Reconstruction:
 End
 Loop
 Double Barrel(Mickulicz)
 Bishop-Koop(distal ileostomy with end to side ileas
anatomosis)
 Santulli(proximal ileostomy with end-to-side
anastomosis)

3. Permanent stoma
● Necessary when there is no
distal bowel segment
remaining after resection or
when for some reason the
bowel cannot be re-joined
● Usually below the belt line
● Permanent colostomy: left
iliac fossa (LIF)
● Permanent ileostomy: right
iliac fossa(RIF)
Temporary stoma
• Relieve complete distal
large bowel obstruction
causing proximal
dilatation

4. Indication of Stoma
1. Feeding
– Percutaneous endoscopic gastrostmoy (PEG)
2. Lavage
– Appendectomy
3. Decompression
4. Diversion
– Protection/defunction of distal bowel anastomosis
● Previous contaminated bowel
● Iliorectal anastomosis
– Urinary diversion following cytectomy
5. Exteriorization
– Perforated or contaminated bowel (distal abscess or fistula)
– Permanent stoma (APR of rectum)

5. Site of abdominal Stoma

6. ●Preparation of patient undergoing Stoma
1. Psychosocial and physical preparation
2. Explanation if indication and complication
3. Request help of Clinical Nurse Specialist in Stoma care
pre-operatively, who will mark the site.
4. Marking the stoma site (Pt standing up)
– Pt able to see the stoma well
– 5 cm from the umbilicus (spino-umbilical line away from all bony
prominence)
– Away from scar & skin creases
– Away from bony points or waistline of clothes
– Easily accessible to Pt (not under a large fold of fat)
5. The stoma within rectus abdominis sheath

7. ●Examination of Stoma
● Inspection
1. Site
2. Types of stoma
3. Surrounding skin
4. Covering of surrounding skin
5. Loop
6. Stoma functioning
7. Stoma discharge
– Colour
– Type
– Amaount
● Palpation
1. General abdominal
palpation
2. Stoma?
● Percussion
– Shifting dullness
● Auscultation
– Bowel sound
● End examination
– PR exam

8. ●Complication of Stoma
● General(d/t u/l dz)
– Stoma diarrhea
● Water&electrolyte
imbalance
● Hypokalemia
– Nutritional disorders
– Stones
● Gallstone
● Renal stone
– Psychosexual
– Residual disease
● Crohn’s disease
● Parastomal fistula
● Specific
– Skin excoriation
– Prolapse/gangrene/ necrosis
of distal end
– Bleeding
– Retraction
– Parastomal hernia
– Fistula formation
– Stenosis of orifice
● Cause constipation
1.Local: skin excoriation, dermatitis, candidiatis, ischaemia,
2.Structural: retracted, prolapse, stenosis, parastomal hernia
(support corset)
3.Systemic:dehydration,electrolyte imbalance, malabsorption

9. INTESTINAL
STOMA
PERMANENT
1. End colostomy
2. End ileostomy
3. Hartsmann’s
procedure(End
colostomy + rectal
stump)
TEMPORARY
1. Loop transverse
colostomy
• emergency procedure:
large bowel obstruction
• defunctioning stoma
• bowel rest: pericolic
abscess, anorectal fistula

10. ILEOSTOMY
essential in the management of neonates with certain
types of distal intestinal obstruction
e.g: long segment Hirschsprung disease, complex
meconium ileus, gastroschisis with atresia
Ileostomies are commonly placed to divert bowel
contents in neonatal necrotizing enterocolitis, ulcerative
colitis, familial polyposis

11. Ileostomy effluent:
Liquid.
Contains activated digestive enzymes.
Discharged almost continuously.
Appearance: sprout of mucosa
-Elevate the ileostomy opening 2-3 cm from
skin to ensure the effluent passes directly
into a stoma bag with minimal contact with
skin.
-Ileum is exerted on itself to form a spout.

12. End Ileostomy

13. Loop Ileostomy

16. Colostomy
A 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
Indication :
 Imperforate anus,
 Hirschsprung disease,
 Abdomino-perineal resection of a low rectal
 anal canal tumour
 diverticular disease.

17. Colostomy
By anatomy :
•Transverse colostomy
•Descending colostomy
•Sigmoid colostomy
By function :
•Decompressing
•Diversion
By construction :
• End
• Loop
• Double barrel

18. COLOSTOMY
●Type:
 Temporary (loop colostomy)
 Permanent (end colostomy)
●Indications:
 Diverticular disease
 Colorectal cancer
●Appearance:
 Flush with the skin (#)
 Mucosa sutured to skin
●Location:
 Permanent at LIF
Temporary at LIF or right hypochondrium
●Effluent:
intermittent and solid

19. Colostomies are sutured flush with skin.
Allowed to pout slightly to prevent retraction after weight gain

20. End Colostomy

21. Double-barrel colostomy
When creating a double-barrel colostomy, the surgeon divides
the bowel completely.(2 stoma besides each other and separate
from each other)
Each opening is brought to the surface as a separate stoma
Proximal-end = end stoma (secrets stool), needs a drainage
bag.
Distal-end= mucous fistula (secretes mucus)
Temporary stoma

24. Hartmann’s Procedure

25.  Surgical diversion of urinary system
 Done for baldder Ca, urinary incontinence and neuropathic
bladders
Formation of urostomy
Needs ileal conduit, a segment of viable ileum mad like a tube where 1 end is open
(used as stoma) and another end is closed( used as reserve).
Ureters are implanted into this isolated segment of small bowel tube
The open-end of conduit is everted to create a similar spout as ileostomy and allows
diversion of urine from kidneys to outside the abdomen and collected by stoma bag
Urostomy

27. Loop stoma – temporary stoma

28. VASCULAR COMPROMISE
● Ischaemia due to operative tissue trauma
● Intestinal necrosis due to ligation of arterial
supply/inadequate collateral arterial circulation
● Venous outflow obstruction > venous
congestion >necrosis of stoma

31. Stoma care
Parents, as well as older children, must be carefully taught and reassured before leaving the
hospital and on subsequent follow-up visits.
Properly fitted appliances should remain in situ for several days (change every 3 days).
There are two basic types of pediatric appliances:
the one-piece pouching system in which the adhesive skin barrier is already attached
to the pouch
the two-piece system in which the adhesive skin barrier is separate from the pouch.
Candidiasis remains a common problem in the parastomal skin, and local antifungal
medication should be used at the earliest sign of irritation.
With skin excoriation, the area is exposed to air and a synthetic barrier is applied. A
hairdryer can be useful.
application of silver nitrate may be necessary to control granulation tissue around the
mucosa-skin interface in the early stages.

32. Colostomy bags and appliances