The document defines a stoma as an artificial opening in the abdominal wall that allows drainage of contents from internal tubular structures like the bowel or ureter. It then focuses on colostomies, defining them as surgical openings made in the large bowel to divert feces and gas to the outside of the body where they can be collected. The document outlines the indications for colostomies, types, postoperative care both in the hospital and at discharge, education of patients and caregivers, and potential complications.

1. STOMAS
FRED MAISO
MAKERERE UNIVERSITY
MR CHUNG

2. (Source; SRB’s manual of surgery, 3rd edition)

3. Definition of Stoma
Stoma is an artificial opening or 'mouth like' to the exterior, the
abdominal wall so as to drain the content from the tubular structures
inside, like bowel or ureter.
It is done for diversion of urine or faecal matter in case
of malignancy, trauma, and sepsis or after surgery
(Source; SRB’s manual of surgery, 3rd edition)

4. Common examples include;
Ileostomy
Colostomy
Vesicostomy
Gastrostomy
Tracheostomy
Cholecystostomy
Etc

5. We shall specifically talk about;
COLOSTOMY
ILLEOSTOMY

6. COLOSTOMY
Colostomy refers to surgical bringing out, through the abdominal wall, a
portion of the large intestine to carry out stool.
(Source; Okello notes of Surgery)
Itis an artificial opening made in the colon to the exterior (skin) to divert
faeces and flatus.
(Source; SRB’s manual of surgery, 3rd edition)
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.
(source; Bailey and Love short practice of surgery)

7. Depending on the purpose for which the diversion has been necessary, a
colostomy may be temporary or permanent.
Indications:
1. Decompress an obstructed colon
2. Evacuation of stool when the distal colon or rectum is removed
like in colorectal cancer
3. To divert the fecal stream in preparation for resection of an
inflammatory, obstructive, or perforated lesion or following
traumatic injury.
4. To protect a distal anastomosis following resection.
(Source; Okello notes of Surgery)

8. Types of colostomy
Classification by nature of stoma;
Loop colostomy
Terminal or end colostomy (Hartman's colostomy)
Double barred colostomy
Classification by function
 temporary (can be loop or double barrel)
 Permanent (Can only be End colostomy)
(Source; Okello notes of Surgery)

9. (Source; SRB’s manual of surgery, 3rd edition)

10. Immediate post operative
General
1.Monitor vital signs every 15 minutes until patient is awake then
30 minutes until patient gets to the ward then every 4 hours
2. IV fluids (NS and Dextrose) at least 500mls every 6 hours
3.Continue prophylactic antibiotics
4. Analgesia- 1mg/kg of pethidine then introduce IM NSAIDs as
decrease pethidine dose.
5.Keep patient nil per oral
6. Keep input and output chart thus keep NG tube, and urethral
catheter.
Source; Okello notes of Surgery)

11. On ward
1.The patient is instructed how to support the operative site during deep breathing
and coughing
2. The stoma is observed for color and amount of wound drainage. Initially, the
colostomy will drain bloody mucus.
3. Fluids and electrolytes are infused intravenously until the patient's diet is can
gradually be resumed, beginning with liquids with the return of bowel sounds.
Usually within 72 hours, passage of gas and stool through the stoma begins.
Initially the stool is liquid, gradually thickening as the patient begins to take solid
foods.
The patient is usually out of bed in 8–24 hours after surgery and discharged in 2–4
days.
Source; Okello notes of Surgery)

12. 4. Counseling
All patients should be counseled about colostomy before surgery and
counseling and education continued after the surgery both within the ward
and even after discharge. The counseling should also include the spouse
and the family members to ensure support of the patient and to continue
his usual lifestyle.
5.Education
During the hospital stay, the patient and his or her caregivers will be
educated on how to care for the colostomy.
i)-Determination of appropriate pouching supplies
ii)Proper application of the pouch on the stoma to avoid leakage
ii)Schedule of how often to change the pouch
iii) Regular assessment and meticulous care of the skin.
iv) diet changes
v)counseling on regular activities and work
Source; Okello notes of Surgery)

13. On Discharge
Skin care
Odour
Life style
Diet
Social support
Doctor consultation
( Source; Okello notes of Surgery

14. colostomy care and the bags.
(Source; SRB’s manual of surgery, 3rd edition

15. Complications of colostomy
Prolapse of mucosa (prolapse of distal loop mucosa is common) -
commonest complication
Retraction
Necrosis
Stenosis

16. Complications of colostomy-continued
Herniation
Bleeding
Diarrhoea
Enteritis
Skin excoriation

17. Complications of colostomy-continued
(Source; SRB’s manual of surgery, 3rd edition)

18. END OF COLOSTOMY PART