The creation of an intestinal stoma remains a vital surgical intervention in the management of various gastrointestinal pathologies. It involves the exteriorization of a segment of the bowel through the abdominal wall, allowing for the diversion of fecal content, either temporarily or permanently. Common indications for stoma formation include intestinal obstruction, gastrointestinal perforation, colorectal malignancies, inflammatory bowel disease, and abdominal trauma—conditions frequently encountered in both elective and emergency surgical settings.

Stomas are classified based on their anatomical origin and configuration, with ileostomies and colostomies being the most prevalent. Ileostomies are often indicated for fecal diversion following proctocolectomy or in cases of distal anastomotic protection, while colostomies are more commonly associated with colorectal malignancies and distal bowel disease. The specific type of stoma—loop, end, or double-barrel—is determined by the underlying pathology and the anticipated need for future bowel continuity restoration.

Despite the therapeutic advantages, stomas are associated with a significant risk of complications. These may include peristomal skin excoriation, stomal prolapse, retraction, necrosis, parastomal hernia, and metabolic disturbances such as high-output ileostomy-induced fluid and electrolyte imbalance. The incidence and severity of these complications can be influenced by patient factors (e.g., age, comorbidities), urgency of surgery, stoma location, and the adequacy of preoperative counseling and postoperative stoma care.

Effective management of these complications begins with proper preoperative stoma site marking by trained personnel, patient education, and meticulous surgical technique. Postoperative follow-up and stoma care guided by enterostomal therapists are equally critical in ensuring favorable outcomes and quality of life for patients.

This study aims to evaluate the clinical indications for intestinal stoma construction, identify common complications, and assess management strategies based on a prospective and retrospective cohort analysis at a tertiary care center. The findings aim to contribute to improved surgical planning and stoma care protocols in patients requiring fecal diversion.

Study Design: Prospective and retrospective observational study

Duration: October 2018 – September 2020

Location: Osmania General Hospital and Niloufer Hospital, Hyderabad

Sample Size: 100 patients

Inclusion Criteria: All patients aged up to 70 years undergoing intestinal stoma construction

Exclusion Criteria: Urinary stomas, gynecological indications, psychological or biochemical complications

Follow-Up: 4 to 24 weeks via in-person interviews or phone Statistical analysis was performed using SPSS v22.0. Chi-square tests were used to evaluate associations.

Investigations

Routine investigations:

• Complete blood count
• Renal function test
• Liver function test
• Serum electrolytes
• Widal test
• X-ray erect abdomen, X-ray chest pa view
• USG abdomen and
• Endoscopy (upper GI endoscopy/lower GI endoscopy)
• Diagnostic laparoscopy

Special investigations:

• T.scan of abdomen and pelvis
• Loopogram
• MRI

Ethical considerations

Ethical clearance was obtained from the Institutional Ethical Committee before conducting the study. Informed consent was obtained from all participants, and their confidentiality and anonymity were maintained throughout the study. No personal identification information was recorded.

• Demographics: 61% male, 39% female. Most common age group: 26–35 and 46–55 years.
• Surgical Timing: 79% emergency, 21% elective. Emergency surgeries often resulted in loop ileostomy.
• Indications: GI malignancies (25%), abdominal trauma (22%)
• Types of Stomata:
• Loop ileostomy: 60%
• End ileostomy: 20%
• Colostomy (various types): 19%
• Complications: 82% experienced complications
• Skin excoriation: 52.4%
• Wound infection: 8.5%

Other complications: prolapse, hernia, fistula, necrosis

• Hospital Stay: Most common duration was 16–20 days (32%)
• Mortality: 2% (2 patients)

1.Primary indications of intestinal stoma

2.Duration of stoma

Table 1: Type of stoma

This study examined the clinical indications, types, complications, and outcomes associated with intestinal stoma construction in 100 patients treated at a tertiary care center. The findings highlight the predominance of loop ileostomy as the most frequently constructed stoma, primarily in patients aged between 26–55 years, with gastrointestinal malignancy and abdominal trauma being the leading indications. Notably, a majority of stomas were constructed in emergency settings, reflecting the acute nature of underlying pathologies such as bowel perforation and obstruction.

The complication rate observed in this study was notably high, with 82% of patients experiencing postoperative issues. The most common complication was peristomal skin excoriation (52.4%), a finding consistent with previous studies, which attribute skin breakdown to continuous exposure to alkaline effluent, particularly from ileostomies. These complications often emerge in the early postoperative period (4–7 days), underscoring the need for robust postoperative monitoring and early stoma care interventions.

In line with earlier research by Shabbir and Britton (2010), who emphasized that most stoma-related complications are preventable with proper technique and education, our findings reinforce the role of preoperative counseling and stoma site marking in reducing morbidity. Despite the high rate of complications, mortality directly attributable to stoma-related issues remained low (2%), suggesting that while common, these complications are generally manageable with prompt and appropriate care.

The correlation between age and stoma type was statistically significant (p < 0.01), with loop colostomies more frequently constructed in neonates and infants, and end ileostomies observed predominantly in older adults. Furthermore, the duration of stoma retention was most commonly 1–2 months, particularly among those who underwent loop ileostomy, supporting its utility as a temporary fecal diversion in colorectal surgeries and trauma cases.

Interestingly, colostomies were more often associated with parastomal hernias and prolapse, whereas ileostomies were more prone to skin-related issues. This anatomical and functional distinction emphasizes the need for tailored follow-up strategies based on the stoma type.

From a surgical standpoint, our data aligns with global evidence indicating that loop ileostomies offer better outcomes in terms of reoperation rates and stoma reversal, especially in cases requiring temporary diversion. However, loop colostomies were associated with higher rates of prolapse and infection, findings that mirror those reported by Klink et al. (2011).

While this study provides important clinical insights, it is not without limitations. Being a single-center study, the generalizability of findings is limited. Furthermore, psychological and quality-of-life impacts—which are significant in stoma patients—were not assessed. Future multicentric studies with long-term follow-up and quality-of-life assessments are warranted to develop more comprehensive management guidelines.

he results of the study support stoma construction most common in the age group between 26-55 years there are likely undergoes loop ileostomy. Less than 1 year of age there are likely undergoes loop colostomy.

Most of the patient undergoes stoma as an emergency procedure rather than elective procedure. Duration of hospital stay approximately 16-20 days, even prolonged when complications occur. The most common indications for stoma construction were gastrointestinal malignancy followed by abdominal trauma.

The most common type of stoma constructed was ileostomy. The next most common stoma constructed was colostomy. The most common complication observed in stoma construction was skin excoriations, followed by laparotomy wound infection.

In conclusion the study showed stoma construction high in adult and old age group, mostly done as an emergency procedure compared to elective procedure. Mostly done for diversion for obstruction or perforation in malignancy and perforation in trauma patients. Most common stoma constructed was loop ileostomy followed by end ileostomy with mucus fistula. There is high incidence of peristomal complication related to that. The complication better managed with proper preoperative planning with effective stoma care in post operative period.

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