Stoma Construction and Care

Abstract

Creation of an enterocutaneous stoma, permanent or temporary, forms an important part in the surgical treatment of colorectal neoplasia but is often also an adjunctive measure in urological and gynecological malignancy. Diverse manifestations of intestinal complications of radiotherapy such as sigmoid strictures, ileo- or rectovaginal fistula, or radiation proctitis with rectal ulcer and stricture may also require the formation of a diverting stoma. Although the psychological and social problems associated with a stoma in these patients treated for cancer may be similar to those with stomas in nonmalignant disease, there are important differences which have to be taken into account in their rehabilitation. Acceptance of the stoma may be more difficult and many patients have to live and cope with uncertainty, particularly those having a palliative stoma. In addition to concern of the stoma, the patient will be fearful of the underlying disease and occasionally be plagued by side effects from chemo- and/or radiotherapy. The care and rehabilitation of these patients therefore require various skills ranging from the medical staff to the stomatherapist and nursing staff, social workers, pharmacist, and dietician, i. e., on a multidisciplinary basis.