Stoma

Stoma specialist nurse – Hazel Kearney Ext 33284

Types of Stomas

1. Ileostomy, Colostomy and urostomy
2. End stoma vs Loop stoma
   • End stoma – only afferent limb present
   • Loop stoma @ defunctioning stoma – afferent and efferent limb present, usually done to protect distal anastomosis after surgery, temporary procedure. May also be done as part of down staging prior to radiotherapy

Early Complications

Vascular

1. Necrosis may occur due to technical errors (impaired/ interrupted blood flow to stoma), most often noticed within 24 hours post surgery
2. Stoma may look dusky/cyanotic, necrosed, oedematous 
3. Gas gangrene – rare but can occur. Discolouration and bubbling under the skin
4. ALL stomas to be checked daily

Late Complications

Skin changes

1. Commonest complication
2. May include contact dermatitis, bleeding from surround skin, skin irritation
3. Can be due to ill-fitted stoma bag – daily measuring of stoma
4. May require steroid cream to settle inflammation (Avoid ointments)
5. Excoriated skin – Orahesive powder to dry area and also help with appliance adherence

High output stoma

1. Normal ileostomy output – 800-1000mls/day. High output – 1000 – 1200mls/day
2. Causes for high stoma – gastroenteritis, partial obstruction, medications, short gut
3. Can lead to dehydration and electrolyte imbalance
4. Management
   1. Treat underlying cause – stool culture
   2. May require IV fluids
   3. Electrolyte replacement – St Marks solution, Dioralyte (6-8 sachets in 1L)
   4. Loperamide – 2mg QDS, doses can be increased up to 56mgs daily 
   5. Codeine phosphate 30mgs TDS – check renal function prior to starting
   6. Octreotide – usually last resort

Parastomal Hernia

1. Can occur around the stoma causing discomfort/ pain
2. Risk factors – age, weight, strenuous/heavy lifting, smoking, heavy lifting
3. Possible to perform repair surgery 
4. Refer to stoma nurse for support garments

Obstruction

1. Not active for >4-6 hours
2. Abdominal cramping, nausea & vomiting, excessive noise
3. Treat as per small/large bowel obstruction – AXR, NG tube, IV Fluids, NBM
4. A catheter can be passed via the stoma if obstruction is due to a kink in the bowel

Prolapse

1. Increased in size and length of stoma, oedematous, areas of bleeding
2. Severe prolapse can lead to ischaemia or obstruction – stoma looks dusky/ cyanotic
3. Initially managed conservatively – manually reducing prolapse with aid of sugar over stoma or dextrose soaked saline and gently knead the prolapse to reduce swelling and application of support binder
4. May require surgical management

Retraction

1. May follow emergency surgery
2. Stoma drops into abdomen
3. Treated with convex products

Separation

1. Separation of stoma from mucosal border
2. Accurate measuring of stoma, fill detached area with orahesive paste
3. May require suture if becomes too large