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7 - Examination of a stoma

from Section 2 - General surgery

Published online by Cambridge University Press:  05 July 2015

By
William Lynn ,
Petrut Gogalniceanu  and
Andrew T. Raftery
Edited by
Petrut Gogalniceanu ,
James Pegrum  and
William Lynn
William Lynn
Affiliation:
General Surgery, London Deanery, London, UK
Petrut Gogalniceanu
Affiliation:
London Postgraduate School of Surgery, London, UK
Andrew T. Raftery
Affiliation:
Sheffield Kidney Institute
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Checklist

WIPER

Physiological parameters

Inspection

Scars:

• Midline laparotomy

• Laparoscopic scars

• No scars and stoma: trephine colostomy

• Linear or purse-string scar in RIF or LIF: reversed stoma

Stoma character:

• Site: RIF vs. LIF

• Spouted vs. flush

• Size of lumen

• Number of lumens

• Stoma bridge

• Bag contents:

•urine (urostomy)

•small bowel contents: liquid (ileostomy)

•formed faeces (colostomy)

Stoma complications:

• Parastomal mass (hernia)

• Dusky or ischaemic mucosa

• Surrounding skin excoriated

• Stoma edge dehiscence

• Stoma retraction

Palpation

• Palpate around stoma and ask patient to cough to exclude parastomal hernia.

• Digitate stoma with a well-lubricated finger (only if required).

Percussion

• Hyper-resonance: bowel obstruction

Auscultation

• Hyperactive bowel sounds in bowel obstruction

• Quiet bowel sounds in ileus

To complete the examination…

• Ask to examine the perineum to determine if the anal orifice is present.

• Perform a full examination of the abdomen.

Examination notes

What is the definition of a stoma?

A stoma is a surgically created communication between a hollow viscus and the skin.

What are the different types of stomas?

  1. • Ileostomy – ileum

  2. • Colostomy – colon

  3. • Urostomy – ileum anastomosed to ureters

How are stomas constructed?

  1. • End-stoma: single lumen. Suggests that the distal end of the viscus has either been resected or closed and left in the abdomen; e.g. Hartmann's procedure.

  2. • Loop-ileostomy: two lumens may be seen. The distal end of the viscus is present but defunctioned, e.g. to allow an anastomosis to heal.

  3. • A urostomy is formed when the urinary bladder has been excised. A loop of ileum (ileal conduit) is separated proximally and distally. The ureters are anastomosed to one end, and the other end is used to form the stoma (urostomy).

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
 , pp. 80 - 83
Publisher: Cambridge University Press
Print publication year: 2015

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