Chapter 9

An intestinal stoma is an opening of the intestinal or urinary tract onto the abdominal wall, constructed surgically or appearing inadvertently. A colostomy is a connection of the colon to the skin of the abdominal wall. An ileostomy involves exteriorization of the ileum on the abdominal skin. In rare instances, the proximal small bowel may be exteriorized as a jejunostomy. A urinary conduit involves a stoma on the abdominal wall that serves to convey urine to an appliance placed on the skin. The conduit may consist of an intestinal segment, or in some cases a direct implantation of the ureter, or even the bladder, on the abdominal wall.

Information about the types and numbers of stomas constructed, complications of stomas, and resultant impairment of an individual's life has been limited because the diseases for which stomas are constructed are not mandated as reportable in the United States. Therefore, the United Ostomy Association of America (UOAA, www.uoaa.org), formerly the United Ostomy Association, a voluntary group of 40,000 members with stomas of various types, undertook the mission of collecting data from patients in the United States and Canada who have an intestinal stoma. A review of 15,000 such entries shows the peak incidence for ileostomy construction owing to ulcerative colitis to occur in persons between 20 and 40 years of age, with a lower peak but in the same age range for patients with Crohn's disease. The second largest peak represents colostomies constructed because of colorectal cancer, and this peak is in patients 60–80 years of age. When complications were analyzed according to original indication for surgery, we found that many patients knew that they had complications but were not aware of the exact nature of the complication. Postoperative intestinal obstruction occurred in all categories of disease, as did retraction of the stoma and abscess formation. There was a preponderance of hernia formation in patients who had surgery for colorectal cancer, whereas abscess, fistula, and stricture formation were the major complications in the patients with Crohn's disease. As new surgical procedures are devised, a justification for their utilization is often the reduction of the level of handicap that exists among patients who have had construction of a conventional ostomy. The UOA survey revealed that patients resumed household activities 90% of the time, vocational activities 73% of the time, social activities 92% of the time, and sexual activities 70% of the time. It is taken into account that patients who have proctectomy for cancer frequently lose their sexual function because of autonomic denervation and not because of the presence of a stoma.

Changes that have improved the quality of life of the patient with a stoma include the development and availability of improved stoma equipment. Specialized surgical techniques, some of which are described in this chapter, have been developed that facilitate the subsequent maintenance of an ostomy. In addition, specialized nursing techniques applied both preoperatively and postoperatively have enhanced the care of the ...

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