What is a stoma, why is it created, and what are its indications?

What is a Stoma?

A stoma is a surgically created opening that connects a portion of the gastrointestinal tract to the skin surface, allowing intestinal contents to drain externally into a collection appliance. 1

Why Stomas Are Created

Stomas serve three primary purposes:

• Fecal diversion from diseased or damaged distal bowel segments
• Protection of high-risk intestinal anastomoses during healing
• Relief of intestinal obstruction or management of severe fecal incontinence

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Major Indications for Stoma Creation

Colostomy Indications

Colostomies (created from the colon) are indicated for:

• Colorectal cancer (most common indication - >75% of all stomas) 1, 3
• Diverticulitis with perforation
• Intestinal trauma
• Crohn's disease
• Fecal diversion needs including:
  • Fecal incontinence
  • Sacral wounds requiring protection
  • Spinal cord injury

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Ileostomy Indications

Ileostomies (created from terminal ileum) are indicated for:

• Colorectal cancer
• Inflammatory bowel disease (IBD)
• Colonic dysmotility
• Temporary protection of distal anastomoses

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Types of Stomas

End Stoma

• The intestine is divided; proximal end brought to skin surface
• Used for permanent stomas or intestinal perforation requiring resection
• Easiest for patients to manage with appliances
• Reversal requires more invasive surgery to locate the distal end within abdomen

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Loop Stoma

• Continuous piece of intestine brought through abdominal wall with anterior opening
• Creates two openings side-by-side within same aperture
• Used for:
  • Distal obstruction (e.g., obstructing cancer)
  • Temporary diversion (protecting anastomosis, allowing sacral wound healing)
• Easier to create and reverse than end stomas

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Clinical Context

Approximately 750,000 Americans live with ostomies, with 130,000 new ostomy surgeries performed annually in the United States. 1 The overall complication rate ranges from 10-70%, making proper stoma site selection and postoperative care critical for patient outcomes and quality of life. 3, 2

Important Distinctions

Colostomies produce formed stool (typically once daily), with appliances changed every 6-7 days. Ileostomies produce liquid effluent requiring emptying 3-4 times daily and wafer changes every 4 days, with higher risk of dehydration and skin complications. 1