Browse the corpus

An intestinal stoma is one of the most common surgical procedures, in which exteriorization of either small bowel or large bowel through the anterior abdominal wall is performed. It may be performed for the management of wide ranges of benign and malignant gastrointestinal conditions on an emergency or regular basis. This activity reviews the indications for intestinal stoma and highlights the role of the interprofessional team in managing patients who undergo stoma formation. Objectives: Identify the indications for an intestinal stoma. Describe the technique of an intestinal stoma. Review the complications of developing an intestinal stoma. Access free multiple choice questions on this topic.

The word stoma or ostomy is derived from the Latin word ostium, which means opening or mouth. An intestinal stoma is one of the most common surgical procedures. The exteriorization of either the small bowel (ileostomy) or large bowel (colostomy) through the anterior abdominal wall is performed. The first recorded intestinal stoma was created by the German surgeon Baum in 1879 to divert an obstructing colon carcinoma.[1] At present, the intestinal stoma is considered one of the most usual life-saving emergency procedures done worldwide.[2] It may be performed to manage wide ranges of benign and malignant gastrointestinal conditions on an emergency or elective basis. In the United States, more than 130.000 intestinal stomas are created per year to address diseases such as colorectal cancer, inflammatory bowel diseases, radiation injury, colonic diverticulitis, and fecal incontinence.[3][4] Intestinal stomas can be temporary or permanent.[5] Although intestinal stomas are considered to be life-saving surgical procedures, they are associated with various complications.

Although stoma formation is a life-saving surgery in managing many gastrointestinal diseases, many patients suffer complications related to the intestinal stoma. Stoma complications can be classified as early or late. Early complications, such as cutaneous irritation or hematoma, are generally treated conservatively. However, late complications such as stoma prolapse and the parastomal hernia can be managed conservatively or surgically. 10% to 70% of patients may develop stoma complications, and their quality of life and their sense of well-being can significantly be affected. The most commonly occurring complications of intestinal stoma include the following:[33][34][35][14][17] Ostomy prolapse Ostomy stenosis Parastomal hernia Cutaneous irritation Ostomy retraction Obstruction/Ileus Ostomy ischemia/necrosis Fluid and electrolyte imbalance Hemorrhage/Hematoma Fistula

Patients undergoing stoma formation require an inter-professional team approach. General surgeons and other specialized surgeons such as colon and rectal surgeons and pediatric surgeons are responsible for performing the operation. However, in the postoperative period management of intestinal stoma is done by nursing staff or entero-stomal therapists. Preoperative stoma education, which is provided by nurse specialists, enables shorter hospital stays for ostomates after the surgery.[36] In addition, a psychologist may be required for patients who experience any psychosocial complications. The whole-team approach is vital in stoma formation and its management. The renewed interest in stoma formation provides for the best patient care and enhances the team’s performance.