Pre-cut skin barriers
~ come in a variety of sizes, so they do not have to be cut. After measuring the stoma with the
measuring guide, the appropriate size opening is selected. Typically, the size should be 1/8 larger
than the stoma measurement to avoid a constrictive opening. These are used a...
inherited disorders such as familial adenomatous polyposis
obstruction of the ureter
stab or gunshot wounds to the abdomen
Depending on the disorder or injury, the ostomy may be temporary, to allow for
healing and a return to normal elimination, or permanent. The three primary types of
ostomy surgery are:
, ✓✓~ colostomy
ileostomy
urostomy
The surgically-created opening in the skin of the abdomen is called a
✓✓~ stoma. A stoma is the communicating end of the bladder or bowel that is brought to the
surface of the abdomen. The location of the stoma depends upon the location of the patient's
beltline, the location of any scars and skin folds, where the damage is, and the type of ostomy
surgery performed. The stoma should be shiny, wet, and red in color, similar to the mucous
membranes of the mouth. A stoma can be round, oval, or irregular in shape, and either protruding,
flush with the skin, or retracted.
A colostomy is created from the end of the large intestine to divert waste from the
digestive system. Three different colostomy types can be formed from the
gastrointestinal tract:
✓✓~ 1. End ( Hartmans pouch)
2. Loop
3. Double barrel
With an end colostomy, t
✓✓~ 1. the damaged section of the bowel is removed and the working end is brought through the
abdomen to the skin surface.
2. When a colostomy is intended to be permanent, an end stoma is typically created.
3. A temporary colostomy may be performed to allow bowel rest or healing, such as
following tumor resection.
,A common temporary colostomy surgery involves
✓✓~ leaving the distal portion of the colon in place, which is oversewn for closure to create what
is known as a Hartmann's pouch. Anastomosis of the severed portions of the colon may be
delayed for several reasons, including bowel inflammation or tumor location.
With a loop colostomy,
✓✓~ a loop of the bowel is brought through the abdomen to the skin surface and temporarily
supported by a plastic bridge or rod. A transverse loop colostomy is typically created as an
emergency procedure to relieve an intestinal obstruction or perforation. A communicating wall
remains between the proximal and the distal bowel. It has two openings through the one stoma -
the proximal end drains stool while the distal portion drains mucus. The bridge can be removed in
7 to 10 days. Transverse loop colostomies are typically temporary.
Loop colostomy
✓✓~
With a double-barrel colostomy,
✓✓~ Two separate stomas are created. Both ends of the bowel are brought through the abdomen
to the skin surface as two separate sections. Typically the distal colon is not removed but
bypassed. The proximal stoma, which is functional, diverts feces to the abdominal wall. The distal
stoma, or mucous fistula, expels mucus from the distal colon.
Depending on the area of disease or injury and other physical features of the
patient's abdomen, a colostomy is placed in one of the following four locations:
✓✓~ 1. Ascending colon
2. Transvers colon
, 3. Descending Colon
4. Sigmoid Colon.
Ascending colon (right abdomen).
✓✓~ The output is typically liquid to semi-liquid and is very irritating to the surrounding skin.
Transverse colon (mid-abdomen). This location is used for a temporary ostomy, with
the stoma constructed as a loop. Output is liquid to semi-formed.
✓✓~ output- liquid to semiformed
Descending colon (left upper abdomen).
✓✓~ The output is semi-formed because more water is absorbed while fecal material is in the
ascending and transverse colon.
Sigmoid colon (left lower abdomen). T
✓✓~ his is the location for a permanent colostomy, particularly for cancer of the rectum. The
stoma is typically located on the lower left quadrant of the abdomen, and the output is formed.
An ileostomy is a surgical opening created in the ileum to bypass the entire large
intestine. A procedure used to treat colon cancer and ulcerative colitis, total
proctocolectomy, involves surgical removal of the entire colon, rectum, and anus,
with closure of the anus, resulting in the need for stool diversion.
✓✓~
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