The problem stoma

Abstract

Creating a stoma requires exteriorization of a segment of bowel to the skin surface, constructed with the end of the bowel or with a loop of bowel. Both colon and terminal ileum may be used in the construction of stomas. Loop stomas are commonly utilized to temporarily divert the fecal stream prior to a definitive procedure, or to protect a tenuous distal anastomosis, and are generally intended to be reversed at a later date. End stomas are more frequently used as definitive therapy with the intention of permanent bowel diversion, but are sometimes utilized in emergency situations such as colorectal trauma and abdominal sepsis, with the potential for later reversal. End stomas generally function better and have fewer complications than loop stomas. Overall complication rates for stomas range from 21 to 70 % [1-3]. Rates of complications are similar between ileostomies and colostomies, although the complication profiles are different. Higher rates of dehydration, leakage, and stenosis are seen with ileostomies while wound infections, prolapse, and parastomal hernias are more frequent in those with colostomies. Other common complications include stoma necrosis, retraction, leakage, and dermatitis. Because of the wide range and variable frequency of complications following stoma creation, it is essential for the general surgeon to have an understanding of the risk factors for, strategies to prevent, options to treat stoma-related complications.