Stoma / OstomyK. Kavindya M. Fernando

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Contents

• What is an ostomy• Types of ostomy• Attachment of stoma appliance• Ileostomy vs colostomy• Loop ileostomy (total procto-colostomy) • Double baral stoma• Complications• Diet • Colostomy irrigation

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What is an ostomy?

• An opening,

• In the small intestine or large intestine,

• Created as an outlet through the anterior abdominal wall,

• In order to pass fecal matter into a bag

• STOMA = part of intestine we use to create this outlet

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Purpose of stoma

• It reduces pain and discomfort

• Allows systematic defication

• May help relieve symptoms of intestinal disease

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Disease conditions where you might need stoma• Inflammatory bowel disease

• Ulcers

• Polyps

• Cancers

• Disorders of bowel function – Hurschprung’s disease

• Accidental injury

• Congenital deformities of anus and rectum

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Type of ostomy

Ostomy

Ileostomy Colostomy

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Stoma of the terminal part of small intestine

An artificial opening made in the large bowel

to divert feceas and flatus to external

environment, where it can be collected into an

external appliance

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Type of ostomy

Stoma

Temporary Permanent

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Stoma of the terminal part of small intestine

An artificial opening made in the large bowel

to divert feceas and flatus to external

environment, where it can be collected into an

external appliance

Attachment of the stoma appliance

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Attachment of the stoma appliance

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Attachment of the stoma appliance

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1. Remove the colostomy bag carefully

Attachment of the stoma appliance

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2. Check the stoma for the colourIf it is black- consult your doctor

Stoma has to be pink, red in colour

Clean the stoma wellLet it dry

Attachment of the stoma appliance

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3. Try using a skin barrier, such as stoma powder.

Sprinkle stoma powder around the stoma.

Be careful not to put the powder on the stoma itself.

Carefully dust it around using a dry wipe, and let the area dry for about 60 seconds.

Attachment of the stoma appliance

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4. Place the transparent stoma template over your stoma, to assess the diameter

Opening should match the diameter – skin irritation

Attachment of the stoma appliance

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Attachment of the stoma appliance

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5. Remove the sticker of the wafer and fix it carefully

Attachment of the stoma appliance

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6. Fix the pouch to the wafer

Clip the other end

Apply micropore plasters around the wafer

Wafer may be left in place for 7 days

Colostomy vs ileostomy

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Colostomy vs ileostomy Ileostomy Colostomy

Sprout + No sprout / flush

Site Usually in RIF Temporary colostomy – transvers or right upper quadrant End colostomy – usually in LIF

Effulent Liquid contain some amount of enzymes (alkali and proteolytic enzymes) excoriation of skin + (Autodigestion)

Solid, hard stools compaired to ileostomy

Watery liquid stools Hard stools

Oddor Oddor + Oddor is more

Frequency of discharge

Higher Lower

Circular folds on the ileum + no

More likely to develop fluid and electrolyte problems JMJ 19

Total procto-colectomy

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Indications

• Familial adenomatous polyposis • Size >1cm• Amount >100 polyps• Microscopy of polyp – villous & tubovillous (less harmful)

• Ulcerative colitis – not responded to medication

• Ulcerative colitis with dysplasia

• UC with perforations

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Indications

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Contents are liquid

Create a pouch to storage functionArtificial pouch

Artificial pouch

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• After anastomosis you have to rest the anastomosis site

• To prevent that –make a loop ileostomy in the RIF to divert feces

• Can reverse after 6/52 when the anastomosis is healed

Loop ileostomy

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Loop ileostomy

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Mucous fistula / Double barrel stoma

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Double barrel stoma

• Bowel is surgically severed and 2 ends are brought out into the abdomen as 2 separate stomas

• Proximal end – functional stoma• Distal end – non functioning (mucus fistula)

• Used in temporary diversion – cases where resection is required due to perforation or necrosis

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Complications of stoma

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Complications

Complications

Early Late

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1. Ischemia2. Bleeding3. Retraction 4. Skin excoriation

1. Prolapse 2. Peristromal hernia 3. Recurrent disease4. Bowel obstruction

Ischemia

• Due to impaired blood flow

• Poor blood supply when stoma is formed• Too tight stoma bag• Too tight dresses over storma

• Management • Close observation during post op period• A clear plastic appliance should be fitted• Avoid tight clothing• Inform your surgeon if you notice any colour change

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Bleeding

• Overenthusuastic cleaning • When using template for measurement• Bleeding from lumen is more serious• Portal HPT in cirrhosis • Recurrence of colonic CA

• Management • Do not rub your stoma• Be careful when applying the bag• Compress with guaze• Usually resolve without interventions

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Retraction

• Recession of the stoma • away from the skin surface • due to excess tension of the stoma

• Insufficiant fixation • Post op weight gain

• Management • Use and appliance with rigid flange• Apply stoma adhesive paste before fixing appliance

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Herniation vs prolapse

Herniation Stoma prolapse

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Excoriation of skin

• Make sure the wafer and the pouch are well fixed

• Control excessive mucus discharge

• Be cautious of the size of the stoma and the wafer

• Use luke warm water and mild soap to clean the peristomalskin

• Never use alcohol agents, savlon, creams, powder or chemical agents to clean

• Never use artificial drying methods. Ex: hair driers

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Excoriation of skin

• Management • Educate the patient about appliance change• Consider a 2 piece appliance to allow healing• Use stoma adhesive powder or pase• Do not use antiseptics for cleaning peristomal skin• Change the base plate as soon as it leaks• A methyl cellulose skin wafer is helpful

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Excoriation of skin

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Ostomy and your diet

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Avoid

• Vegetables – raddish, cabbage, garlic, cucumber, kno-kol• Are known to result in offensive odour

• Carbanoted beverages, chewing gum and smokinh• Causes excess gas in stoma appliance

• High and moderate fiber diet

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Low fiber diet (0-10%)

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Vegetables 1. Beans2. Carrot3. Onion4. Chillies5. Tomato6. Cabbage7. Kankun Fruits

1. Orange 2. Dates (dried)3. Passion fruit

Animal products 1. Eggs2. Prawns 3. Milk4. Cheese 5. Butter

Pulses 1. Green gram2. Dhal3. Soya bean 4. Cowpee

Cereal1. Barley 2. Maize 3. Kurakkan4. Rice (raw-

white)5. Rice (parboiled-

white)

Advices

• Chew your food well and consume adequate amounts of water

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Colostomy irrigation

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Colostomy irrigation

• Normally done in patients with a• Permement colostomy• Who need bowel preparation for special investigations –colonoscopy

• Usually done it after 1 year of stoma creation

• Takes about 45 minutes

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Contraindications

• Ileostomy

• Ascending colon stoma

• Transverse colon stoma

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Requirement for stoma irrigation

• 1.5 – 2 L of luke warm water

• Resovior bag

• A tube with a controller and a funnel shaped introducer, which prevents damage to stoma

• 2 clips to close the bag

• Bag to discard feces

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Requirement for stoma irrigation

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Requirement for stoma irrigation

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Thank You!

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