Stoma

Anatomi Abdomen

Usus Besar

Mengabsorbsi

cairan dan elektrolit

Reservoir massa faeses
Dengan bantuan bakteri sintesis vitami

The physiology of the colon should be taken into

account when considering stoma construction.
The right side of the colon absorbs water and
has irregular peristaltic contractions.
Stomas made from the proximal half of the colon
usually expel a liquid content.
The left colon serves as a conduit and reservoir
and has a few mass peristaltic motions per day .
The content is more solid, and in many cases the
stoma output can be regulated by irrigation.
Proximal colostomies should be avoided , as they
will combine the worst features of both a colostomy
and an ileostomy: liquid, high-volume, foul-smelling
effluent. The left colon should be used for a
colostomy if possible; the distal transverse colon is
also a reasonable choice.

Lokasi Stoma yang baik

Lokasi Stoma

The most common indication is cancer of

the rectum.
Colostomy is an opening of the large
intestine, no sphincteric control better
on the abdominal wall than in the
perineum (maintanence).
Colostomies are also constructed as
treatment for obstructing lesions of
the distal large intestine and for actual or
potential perforations.

Colostomy

End sigmoid
Descending

Emergency / elektif

Sementara / permanent

Kanker rektum (abdominoperineal reseksi)

Tujuan hygiene (tetraplegia / inkontinensia
alvi)
Diversi faeses
Obstruksi
Perforasi
Kasus trauma

Type by Anatomic Location

Type of colostomy categorized by the part of the colon

used in its construction.
The most common type : "end-sigmoid" colostomy.
However, if the inferior mesenteric artery is transected
during an operation for cancer of the rectum, the
blood supply to the sigmoid colon is no longer
dependable, and it should not be used for stoma
construction.
"end-descending" colostomy is preferable to an endsigmoid colostomy.
Other types of colonic stomas include the transverse
colostomy and cecostomy.

Type by Function
More important than the anatomy of
the colon is the function that the
colostomy is intended to perform.
There are two considerations:
(1) to provide decompression of the
large intestine
(2) to provide diversion of the feces.

Diverting Colostomy

A diverting colostomy is constructed to provide

diversion of intestinal content. It is performed
because the distal segment of bowel has been
completely resected (as during
abdominoperineal resection), because of known
or suspected perforation or obstruction of the
distal bowel (e.g., obstructing carcinoma,
diverticulitis, leaking anastomosis, or trauma),
or because of destruction or infection of the
distal colon, rectum, or anus (e.g., Crohn's
disease or failed anal sphincter reconstruction).

Perawatan stoma

Waktu yg tepat untuk mengganti kantung

Frekuensi mengganti kantung
Proteksi kulit peristoma
Kontrol bau & gas
Management diare
Pencegahan & management gangguan
cairan & elektrolit
Pencegahan & management konstipasi
Irigasi stoma

Komplikasi

Metabolik problems
Parastoma abses, ulcerasi, hernia
Striktur
Volvulus
Caput medusae