Definitions
Stomas
A stoma is an opening from a hollow viscus connecting it to the skin surface. A gastrostomy is an opening into the stomach which is maintained by inserting a tube. An ileostomy is an opening in the small intestine. A colostomy is an opening in the large intestine. A urostomy is an external opening in the urinary tract. The most common form is a short length of ileum formed into a stoma and connected to the urinary tract (ureters) to act as a conduit for urine (ileal conduit).
Incisions
A laparotomy is any incision in the abdominal wall but usually used to refer to anterior (para)midline approaches.
Key Points
- Ileostomies and urostomies are usually spouted to reduce the risk of the output causing irritation of the surrounding skin.
- Colostomies are usually flush to the skin.
- Don’t assume what type of stoma is present by its location.
Indications for Common Stomas
- Gastrostomy:
temporary: inability to swallow (e.g. post CVA, during pharyngeal DXT)
permanent: loss of swallowing (e.g. MS, MND)
- Ileostomy:
permanent end: total proctocolectomy for ulcerative colitis
temporary end: post-emergency right hemicolectomy/ileocaecal resection without anastomosis
loop: relief of distal obstruction; protection of distal anastomosis, diversion of the faecal stream (may be temporary)
- Colostomy:
permanent end: abdominoperineal resection of rectum and anal canal for very low rectal carcinoma
temporary end: sigmoid colectomy for complications of carcinoma or diverticulitis (Hartmann’s procedure)
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