Examination of a Stoma

A stoma is a surgically created opening into a hollow organ. It is usually covered by a removable pouching system that collects the output for disposal.

Common examples include a colostomy (opening into large bowel), ileostomy (ileum), and urostomy (urinary system). In this article, we shall look at how to perform an examination of a stoma.

Introduction

• Introduce yourself to the patient
• Wash your hands
• Briefly explain to the patient what the examination involves and ask their permission to examine them
• Position the patient at 45^o

Before starting any examination of a stoma, ask the patient if they have any pain in their abdomen and if they have had any problems with their stoma (such as pain around the stoma or a change in output).

Inspection

CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

Figure 1 – A healthy ileostomy

Ask the patient to fully expose their stoma site (ideally you should ask the patient if they would be able to remove their stoma bag). Most of the examination of a stoma comes from inspection, in which you should be commenting on the:

• Site
  • If situated in the left iliac fossa, it is probably a colostomy
  • If situated in the right iliac fossa, it is probably an ileostomy
• Spout
  • A spouted stoma will be an ileostomy (or urostomy) as small bowel contents are an irritant to the skin, whereas a stoma flush with the skin will be a colostomy
• Consistency
  • Colostomy output is generally thick and sludgy (like faeces), whereas an ileostomy is waterier and often greener, and a urostomy will produce urine

• Number of lumens
  • Loop stomas will have two lumens, whilst end stomas will have one lumen

Observe for any potential common complications of a stoma, such as parastomal hernia (common with colostomies), prolapse, retraction, or infarction (whereby the stoma is turning jet black).

Check the surrounding skin for any evidence of erythema, ulceration, or fistulation.

Palpation

• Gently feel around the stoma site for any tenderness
• Ask the patient to cough and feel for a cough impulse for any obvious parastomal hernia
• Gently digitate the stoma to assess for any stenosis and check patency

Completing the Examination

Remember, if you have forgotten something important, you can go back and complete this.

To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform a full GI examination.