Poor Placement
This photograph show the siting of a fresh stoma (x) prior to re-siting a new stoma.
Stoma being placed in the left iliac fossa on a flat area away from the superior anterior iliac spine and the midline wound.
Photograph of colostomy with stoma bag in an appropriate position. Lying on a flat area in the left iliac fossa and away from bony pelvis.
Photograph showing poor positioning of a stoma, which lies in a skin crease. The patient has multiple scars following recurrent CD.
Photograph of a patient with Crohn's disease. Note high position of ileostomy due to difficulty with a badly scarred abdomen produced by multiple operations.
It is important to site the stoma in a suitable position. To achieve this it is important place the stoma:
- on a flat an area as possible (avoiding skin crease)
- away from bony prominences
- away from abdominal incision
N.B. This can be planned when surgery is elective. However when the surgery is performed in an emergency, planning the stoma site is limited.
Elective surgery
- Site chosen by either surgeon or experienced stoma nurse
- Bag is stuck on chosen site and:
- Partially filled with fluid
- Patient lies down and walks around
- Patient bends down
- Patient wears normal clothes and belt
- The position is adjusted accordingly
Emergency surgery
- Unable to plan
- Patient may gain weight postoperatively when health regained (position of stoma may change)
N.B. If the stoma is wrongly sited, the bag will not adhere properly which will lead to leakage, skin excoriation and further problems with adherence. Thus a vicious circle ensues!
