Makindo Medical Notes

Introduction

A surgical stoma is a surgically created opening that connects an internal organ to the outside of the body, allowing waste or fluids to be diverted from their normal route. Stomas are typically formed when normal bodily functions are impaired due to disease, injury, or surgery. Understanding stoma formation and care is essential for healthcare providers managing patients with various conditions.

Types of Surgical Stomas

• Colostomy: A stoma formed by diverting the colon to an opening in the abdominal wall. It is typically used for conditions such as colorectal cancer, diverticulitis, or inflammatory bowel disease.
• Ileostomy: A stoma created from the ileum (the last part of the small intestine) to divert the contents of the digestive tract. This is often used for conditions affecting the colon, such as ulcerative colitis or Crohn’s disease.
• Urostomy: A stoma used to divert urine from the urinary tract when the bladder is nonfunctional or removed. Common forms of urostomy include the ileal conduit, in which a piece of the ileum is used to form a conduit to the outside.
• Gastrostomy (G-tube): A stoma created in the stomach for feeding purposes, commonly used when the patient cannot swallow or absorb nutrients through normal digestion.

Indications for Stoma Formation

Stomas are typically formed when normal bowel, urinary, or respiratory function is impaired due to disease or injury. Indications include:

• Colorectal Cancer: A common reason for colostomies and ileostomies to bypass diseased areas of the colon or rectum.
• Inflammatory Bowel Disease (IBD): Patients with Crohn’s disease or ulcerative colitis may require an ileostomy or colostomy when medical treatment fails or when complications arise, such as perforation or severe bleeding.
• Obstruction or Trauma: Severe obstructions, trauma to the abdomen, or bowel perforation may necessitate the formation of a stoma to bypass the damaged areas.
• Bladder Cancer or Congenital Conditions: Urostomies are often required in patients undergoing cystectomy or those with congenital urinary tract malformations.
• Neurological Conditions: Neurological diseases that affect swallowing, such as stroke or ALS, may require a gastrostomy for feeding.

Procedure of Stoma Formation

The procedure to create a stoma varies depending on the type and purpose of the stoma. It generally involves the following steps:

• Preparation: The patient is evaluated for appropriate stoma placement. For example, the location on the abdomen is chosen to ensure comfort, ease of access, and minimal interference with the patient’s daily activities.
• Anesthesia: General or regional anesthesia is typically used, depending on the complexity of the procedure.
• Incision and Creation: The surgeon makes an incision in the abdominal wall (or other area, depending on the stoma type) and brings a portion of the intestine or other organ to the surface to form the stoma.
• Securing the Stoma: The stoma is carefully secured in place and the bowel or organ is sutured to the skin to prevent leakage.
• Postoperative Care: The patient is monitored for complications such as infection, bleeding, and stoma function. Stoma care education begins early.

Stoma Care and Maintenance

Proper stoma care is critical for preventing complications and ensuring the patient’s comfort. Some key points of stoma care include:

• Cleaning: The stoma should be cleaned regularly with mild soap and water to prevent infection. The surrounding skin should be kept dry and free from irritation.
• Pouch Management: Stoma pouches should be emptied when they are one-third full and changed regularly to maintain skin integrity and prevent odor.
• Skin Protection: Barrier creams or pastes can be used to protect the skin around the stoma from leaks and irritation.
• Diet and Hydration: Patients should be educated on maintaining a balanced diet and staying hydrated to avoid stoma-related complications such as blockage or dehydration.
• Monitoring for Complications: Regular check-ups to monitor for signs of infection, leakage, or stoma-related issues are essential.

Psychosocial Aspects of Stoma Care

Patients who undergo stoma formation often face significant psychological and emotional challenges, including body image concerns and social stigma. Addressing these issues is critical for improving overall patient well-being:

• Body Image and Self-Esteem: Many patients feel self-conscious about their stoma and may experience depression or anxiety related to the change in their appearance and bodily functions.
• Social Support: Providing counseling and support groups for stoma patients can help alleviate feelings of isolation and encourage them to re-engage in social activities.
• Sexual Health: Some patients worry about the impact of a stoma on their sexual health. It is essential to provide information and support regarding intimacy after surgery.

Complications Associated with Stomas

Although stomas are lifesaving interventions, there are potential complications that can arise both in the short and long term:

• Stoma Prolapse: When the stoma becomes elongated or protrudes further than normal, it may require surgical intervention.
• Stoma Retraction: The stoma may recede into the abdominal wall, causing difficulties in pouch management and leakage.
• Peristomal Skin Issues: Skin irritation, infection, or breakdown around the stoma site can occur due to leaks or improper pouch fitting.
• Blockages: A stoma can become blocked due to food, medication, or debris obstructing the opening, causing discomfort or nausea.
• Electrolyte Imbalance: Ileostomies and colostomies can lead to fluid and electrolyte imbalances, particularly if the patient is not properly hydrated.

Conclusion

Surgical stomas are a critical part of patient management in cases of gastrointestinal, urinary, or respiratory failure. Proper understanding of the types, indications, creation, care, and potential complications of stomas is vital for healthcare professionals. Early education on stoma care, psychosocial support, and patient involvement in the decision-making process can significantly improve patient outcomes and quality of life.