Intestinal Ostomy

Abstract

Background: About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired quality of life. Optimal ostomy creation and proper ostomy care are crucially important determinants of the success of treatment and of the patients' quality of life.

Methods: This article is based on pertinent publications retrieved by a selective search in PubMed, GoogleScholar, and Scopus, and on the authors' experience.

Results: Intestinal stomata can be created using either the small or the large bowel. More than 75% of all stomata are placed as part of the treatment of colorectal cancer. The incidence of stoma-related complications is reported to be 10-70%. Skin irritation, erosion, and ulceration are the most common early complications, with a combined incidence of 25-34%, while stoma prolapse is the most common late complication, with an incidence of 8-75%. Most early complications can be managed conservatively, while most late complications require surgical revision. In 19% of cases, an ostomy that was initially planned to be temporary becomes permanent. Inappropriate stoma location and inadequate ostomy care are the most common causes of early complications. Both surgical and patient-related factors influence late complications.

Conclusion: Every step from the planning of a stoma to its postoperative care should be discussed with the patient in detail. Preoperative marking is essential for an optimal stoma site. Optimal patient management with the involvement of an ostomy nurse increases ostomy acceptance, reduces ostomy-related complications, and improves the quality of life of ostomy carriers.

Figures

Figure 1

Classification of intestinal ostomies. Enterostomies are classified first by the segment of intestine brought out to the surface and then, according to the number of openings in the intestine, into loop ostomies and end ostomies

Figure 2

End (terminal) colostomy. 1. End ostomy; 2. abdominal wall; 3. artificial mesh; 4. colon; 5. mesenterium; 6. peritoneum

Figure 3:

Loop ileostomy. 1. Proximal segment of small intestine; 2. distal segment; 3. mesenterium, 4. cecum; 5. appendix

eFigure

Ostomy complications a) Cutaneous irritation with ulceration b) Ostomy necrosis c) Ostomy prolapse d) Ostomy retraction e) Ostomy stenosis f) Parastomal hernia