Features of ileostomies vs colostomies

• An ileostomy is usually in the right iliac fossa , a colostomy is usually in the left iliac fossa.
• An ileostomy contains liquid small bowel contents, a colostomy contains solid formed faeces.
• An ileostomy end is spouted (small bowel contents are irritant to the surrounding skin), a colostomy end is flush with the skin.

An important question to ask is whether the patient has an anus and whether the stoma is end or loop.

A patient with an ileostomy and no anus has had a panproctocolectomy, most likely for ulcerative colitis.

For patients with an ileostomy and an anus, it is helpful to check whether there is a loop or end ileostomy:

• In a loop ileostomy 2 bowel ends are visible. The patient is likely to have had an anterior resection (for high rectal cancer) with formation of a temporary loop ileostomy (to allow for healing of the distal anastomosis).
• In an end ileostomy 1 end of bowel is visible. The patient may have had a sub-total colectomy with formation of a rectal stump and temporary end ileostomy. This may be done as an emergency for fulminant ulcerative colitis or C. diff colitis.
• A patient with a colostomy and no anus is likely to have had an AP resection (for low rectal cancer).
• A patient with a colostomy and an anus is likely to have had an emergency Hartmann's procedure. The stoma is temporary and can be reversed.

Note that end colostomies are more common than loop colostomies. Loop colostomies are an option for inoperable rectal cancer to prevent distal obstruction.

Complications of stomas

Complications can be classified into early and late complications.

Early Complications of stomas

Early complications can be further classified into mechanical and functional complications.

• Early mechanical complications include bowel ischaemia/necrosis, bowel retraction, and para-stomal abscess formation.
• Early functional complications include poor stoma function and high output stoma.