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Stomas (Viva (Hx (Surgery, Output, Pain, Complications, Psychosexual…

- - - - Perforated or contaminated bowel: e.g. Hartmann’s
      - Permanent: e.g. AP resection
    - - Protection of distal anastomosis
        
        Contamination: e.g. faecal peritonitis
        
        Anatomical: e.g. ileorectal anastomosis
      - Acute Crohn’s
      - Urinary diversion following cystectomy
- - - - No. of lumens
      - Health of mucosa and surrounding skin
      - Strictures
      - Prolapse
  - - - No scars = colonoscopy assisted
        trephine colostomy
- - - - Done w/ pt. standing up to ensure pt. can see stoma.
      - Avoid
        
        Bony prominences
        
        Skin folds/creases
        
        Waistline
        
        Old wounds
        
        Umbilicus
      - Choose
        
        A site that is accessible to the pt.
        
        Ideally below the belt line for concealment
        
        w/i the rectus: ↓ risk of hernia or prolapse
  - - - Early
        
        Haemorrhage
        
        Ischaemia
        
        High output (can → ↓K+)
        
        Loperamide ± codeine to thicken output
        
        Parastomal abscess
        
        Stoma retraction
      - Delayed
        
        Parastomal hernia (on lateral side)
        
        Obstruction: adhesions or herniation through lateral
        space around stoma
        
        Dermatitis (esp. ileostomy)
        
        Stoma prolapse
        
        Stenosis or stricture
        
        Fistulae
        
        Psychosexual dysfunction
- - - - Ileal Conduit: Incontinent
        
        Ureters attached to a portion of resected ileum which is
        exteriorised as a spouted stoma.
        
        Bowel continuity maintained by primary anastomosis.
        
        Urine collected in a bag.
      - Indiana Pouch: Continent
        
        Pouch created from ~2ft of resected ascending colon and
        portion of ileum which includes the ileocaecal valve.
        
        Ureters anastomosed to colonic end and ileal end
        exteriorised as spouted stoma.
        
        Ileocaecal valve prevents urinary leak from the pouch.
        
        Pt. self-catheterises to drain pouch.