Stomas – surgically created opening between bowel & skin
Total colectomy
 Panproctocelectomy & ileostomy
 Colectomy & ileo-anal anastomosis (restorative proctocolectomy)
Ileostomy
 Right lower quadrant = ileostomy
 Spout – contents irritant to skin (corrosive)
 Liquid faeces
 Permanent end ileostomy = total colectomy
— Ulcerative colitis or familial polyposis
 Temporary ileostomy = emergency sub-total
colectomy with over-sewing of rectum
— Toxic megacolon
 Loop ileostomy – bowel temporarily
defunctioned – gives anastomosis time to heal
— Reversed after 6/52
— Anterior resection
— Rod under to stop downstream bowel
— Diverticular disease, UC
Urostomy/Ileal Conduit – R. iliac fossa
 Performed after cystectomy for invasive bladder cancer (T2-T3 –
penetrating muscle)
 Ureters too fine to be brought directly to surface  length of ileum isolated
but left on vascular pedicle
 Ureters implanted into ileal reservoir (after bladder removed)
 Distal end brought our as
ileostomy (with spouteverted end)
 Catheter left in situ post-op
to reduce stricture formation
 Complications:
 UTI
 Stricture of ureter or
ileum → obstruction
& hydronephrosis
 Ischaemia of ileum
or spout
 Parastomal hernia
 Renal stones/failure
Colostomy
 Left iliac fossa
 Flush to skin
 Solid faeces
 AP (abdomino-perineal) resection – permanent
 Low rectal tumour
 Hartmann’s procedure – emergency colonic
resection, rectal stump oversewn - temporary
LIF colostomy → reversed after a few months
 Perforated diverticulitis, obstructed colon cancer
Complications of Stomas
 Fluid loss
 Odour
 Ulceration of skin
 Leakage
 Stenosis
 Hernia (parastomal) or prolapse
 Ischaemia
 Terminal ileum loss (failure to absorb bile salts & B12
 Sexual & psychological problems
 Hyperchloraemic acidosis
— Bowel mucosa contains ion pump that exchanges chloride for
bicarbonate
— Urinary chloride absorbed & bicarbonate in exchange →
hyperchloraemic acidosis (due to loss of bicarb)
— More common with ureters transplanted into large bowel than ileal
conduit
Complications of Stomas
 Immediate:
 Haemorrhage
 Ischaemia
 Infection
 Early:
 Electrolyte abnormality
 Retraction
 Obstruction

Late:
 Prolapse
 Fistula
 Parastomal hernia
 Dermatitis
 Psychological problems