Surgical Stomas

🧠 A stoma is a surgically created opening between an internal organ and the skin surface. It allows faeces, urine, or feeds to bypass the normal route when disease, obstruction, trauma, or surgery prevents normal function.

🔀 Main Types of Stoma

• 🟤 Colostomy: colon brought to the abdominal wall to divert formed or semi-formed stool.
• 🟡 Ileostomy: ileum brought to the abdominal wall to divert small bowel effluent.
• 🟦 Urostomy: urinary diversion, commonly an ileal conduit after cystectomy.
• 🍽️ Gastrostomy: opening into the stomach for long-term feeding.

🟡 Ileostomy vs 🟤 Colostomy

🎯 Indications for Stoma Formation

• 🎗️ Colorectal cancer: obstruction, resection, low rectal surgery or palliative diversion.
• 🔥 Inflammatory bowel disease: severe ulcerative colitis, Crohn’s complications, perforation or failure of medical therapy.
• 🚧 Bowel obstruction or perforation: to divert faecal flow and protect the patient.
• 🩸 Trauma or ischaemia: when bowel continuity is unsafe.
• 🛡️ Protective stoma: temporary ileostomy or colostomy to protect a distal anastomosis.
• 🟦 Bladder cancer: urostomy after cystectomy.
• 🍽️ Unsafe swallow: gastrostomy for long-term enteral feeding.

🔧 Temporary vs Permanent Stomas

• ⏳ Temporary stoma: created to divert flow while bowel heals; may be reversed later.
• ♾️ Permanent stoma: required when the distal bowel, rectum, anus, or bladder has been removed or cannot function safely.
• 🔁 Reversal depends on the original disease, surgical anatomy, fitness, continence, healing and patient preference.

🧼 Stoma Care Basics

• 🧽 Clean the stoma and surrounding skin with warm water; avoid harsh products.
• 👜 Empty the pouch when about one-third full to prevent leakage and pulling.
• 🛡️ Protect peristomal skin with a well-fitting appliance, barrier ring, paste or spray if needed.
• 👀 Check the stoma colour: healthy stoma should be pink/red and moist.
• 🚨 Seek help if the stoma becomes dusky, black, very painful, stops working, or bleeds heavily.
• 👩‍⚕️ Early input from a specialist stoma nurse improves confidence, appliance fit and skin outcomes.

💧 High-Output Ileostomy

• 🟡 Ileostomies can produce large volumes of fluid, especially soon after formation.
• High output can cause dehydration, AKI, sodium depletion and electrolyte disturbance.
• Monitor fluid balance, weight, U&Es, magnesium and urine output.
• Encourage appropriate oral rehydration solution rather than excess plain water if output is high.
• Consider antimotility therapy such as loperamide under surgical/stoma-team guidance.

⚠️ Complications

• 🔴 Ischaemia/necrosis: dusky or black stoma, usually early postoperative.
• 🕳️ Retraction: stoma sinks below skin level causing leakage and poor appliance fit.
• 📈 Prolapse: bowel protrudes excessively through the stoma.
• 🧱 Parastomal hernia: bulge around the stoma due to abdominal wall weakness.
• 🔥 Peristomal skin damage: irritation from leakage, poor fit, adhesive reaction or infection.
• 🚧 Obstruction/blockage: colicky pain, nausea, vomiting and reduced output.
• 💧 Fluid/electrolyte loss: especially with ileostomy or high-output stoma.

🧠 Psychosocial Care

• 🪞 Stomas can affect body image, mood, confidence, clothing choices and sexual wellbeing.
• 💬 Patients need clear education, practical appliance support and time to adjust.
• 🤝 Stoma nurses, peer support and patient groups can improve adaptation and quality of life.
• ❤️ Ask sensitively about intimacy, work, travel, sleep and anxiety — many patients will not volunteer these concerns.

🎓 Exam Tips

• 🟡 Ileostomy = liquid output, higher dehydration and electrolyte risk.
• 🟤 Colostomy = more formed stool, lower fluid loss risk.
• 🚨 A dusky, black, very painful or non-functioning stoma is urgent.
• 💧 High-output ileostomy can cause AKI — check U&Es and magnesium.
• 🧑‍⚕️ Always involve the stoma nurse early.

🧠 Memory aid: 🟡 Ileostomy = ileum = irritant liquid output + dehydration risk.
🟤 Colostomy = colon = more formed stool + lower fluid loss risk.