Clinical study of intestinal stomas- Its indications and complications

INTRODUCTION

The term ‘stoma’ originates from the Greek word meaning mouth. Gastrointestinal stomas are artificial openings that connect the gut to the skin, used for fecal diversion in a variety of clinical conditions.¹ The construction of intestinal stomas, whether temporary or permanent, plays a vital role in the management of intestinal obstruction, perforation, inflammatory bowel disease, trauma, and malignancy.^2-4 Despite their life-saving purpose, stomas can lead to complications, often devastating, like stoma necrosis, retraction, stenosis or stricture, prolapse, parastomal hernia, etc., leading to significant physiological, mechanical, and psychological implications.^5-8

The outcome varies in patients according to their indications, age, sex, nutritional status, type of stoma, type of procedure, and site of stoma.⁹ This study aims to evaluate the indications, complications, and outcomes of intestinal stomas in patients at a tertiary care hospital.

MATERIALS AND METHODS

Study design:Prospective observational study.

Study site: Department of General Surgery, B J Medical College & Civil Hospital, Ahmedabad.

Study duration: June 2023 to May 2025.

Sample size: 100 patients.

RESULTS

The key demographic and clinical observations are summarized below:

The majority of patients (55%) were middle-aged (41–60 years), followed by younger adults (23%) and elderly patients (22%) [Figure 1].

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Figure 1: Age distribution.

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Males predominated with a male-to-female ratio of ~2:1 [Figure 2].

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Figure 2: Gender distribution.

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Emergency stomas constituted 86% of cases, while elective stomas accounted for 14% [Table 1].

Abdominal pain (100%) was the most common symptom, followed by distension (60%) [Table 2].

Indications of a stoma

The commonest indication was hollow viscus perforation (38%), followed by intestinal obstruction (30%), mesenteric ischemia (12%), and malignancy (7%) [Figure 3].

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Figure 3: Indications for stoma.

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Loop ileostomy was the most frequent stoma constructed (60%), followed by end ileostomy (15%) and loop colostomy (15%), and then end colostomy (7%), followed by end jejunostomy (3%) [Table 3].

Loop ileostomy was the most frequently constructed type (60%) [Table 3].

Table 3: Types of ostomy

Type of stoma	No. of patients (n=100)	Percentage (%)	Ahmad13 (n=100) (%)
Loop ileostomy	60	60	64
End ileostomy	15	15	9
End jejunostomy	3	3	3
Loop colostomy	15	15	9
End colostomy	7	7	11

Most stomas were temporary (95%) [Table 4].

Table 4: Nature of stoma constructed

Nature of stoma	No. of patients (n=100)	Percentage (%)	Adarsh14 (n=60) (%)
Permanent	5	5	6.66
Temporary	95	95	93.33

Complications of stoma

Early complications included peristomal skin irritation (51.2%), stoma retraction (12.2%), ischemia or necrosis (7.4%), and peristomal sepsis (7.4%). Similar complication patterns have been described in previous tertiary care studies. Late complications consisted of parastomal hernia (3.65%), prolapse (1.2%), and stenosis (4.9%) [Figure 4].

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Figure 4: Complications of stoma construction.

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Complications varied between ileostomies and colostomies, as shown in Table 5.

Table 5: Distribution of complications of ostomy

Complications	Ileostomy			Colostomy
No.	(%)	Ahmad Z (n=87) (%)	No.	(%)	Ahmad13 (n=87) (%)
Peristomal dermatitis	37	56.9	50	5	29.4	43
Peristomal sepsis	4	6.2	9.2	2	11.8	5
Mucocutaneous separation	2	3.1	9.2	1	5.88	4.8
Stoma necrosis	5	7.7	5.2	1	5.88	0
Stoma retraction	9	13.8	2.6	1	5.88	0
Stoma prolapse	0	0	2.6	1	5.88	19
Parastomal hernia	1	1.5	3.9	2	11.8	19
Stoma stenosis	2	3.1	5.2	2	11.8	0
Stoma bleeding	2	3.1	7.8	1	5.88	4.8
Stoma diarrhea	3	4.6	4	1	5.88	4.8
Total	65	100	100	17	100	100
Grand total	82

Complications were more common in emergency procedures [Table 6].

Table 6: Mode of surgery

Mode of surgery	Complication count (n=82)	Percentage (%)	Rajsekhar et al.15 (n=18) (%)
Elective	11	13.4	28
Emergency	71	86.6	72

Loop ileostomies showed the highest complication rate [Table 7].

Table 7: Complications based on the type of stoma

Type of stoma	No. of patients (n=82)	Percentage (%)	Rajsekhar et al.15 (n=18)
Loop ileostomy	52	63.4	12
End ileostomy	10	12.2	2
End jejunostomy	3	3.65	0
Loop colostomy	12	14.6	2
End colostomy	5	6.1	2

Most complications were managed conservatively (70.7%) [Table 8].

Table 8: Management of complications

Management	No. of patients (n=82)	Percentage (%)
Conservative	58	70.7
Surgical	24	29.3

Surgical management included local repair, stoma revision, and laparotomy [Table 9].

Table 9: Distribution of surgical management

Surgical Mx	No. of patients	Percentage (%)
Local repair	5	20.8
Revision of stoma	6	25
Laparotomy	13	54.2
Total	24	100

Diabetes mellitus (24%) was the most common comorbidity [Table 10].

Table 10: Distribution of cases based on comorbidities

Comorbidities	No. of patients	Percentage (%)
Hypertension	18	18
Diabetes mellitus	24	24
IHD	5	5
Tuberculosis	18	18
Previous abdominal surgery	5	5
Obesity	5	5

IHD: Ischemic heart disease

In the current study, the average duration of hospital stay is 7.5 days [Table 11].

Table 11: Distribution of cases based on hospital stay

Hospital stay (days)	No. of patients (n=100)	Percentage (%)
<7	72	76
7-15	18	14
>15	10	10

Overall mortality was 7% [Table 12].

Table 12: Distribution of cases based on outcome

Outcome	No. of patients (n=100)	Percentage (%)
Discharge	93	93
Death	7	7

DISCUSSION

Intestinal stoma construction remains a common surgical procedure, particularly in emergency settings.^1-4 In the present study, stoma creation was more frequent in males and in the middle-aged group (41-60 years). Similar demographic trends have been reported in previous literature.^5-8 Exploratory laparotomy with stoma formation was predominantly performed in emergency cases, largely due to hollow viscus perforation and intestinal obstruction, which aligns with established surgical principles.^9-12 Loop ileostomy was the most frequently constructed stoma in our study due to its technical ease, lower risk of distal anastomotic leak, and relative simplicity of reversal.^13-15 Most stomas were temporary and were closed within 3-6 months once the underlying pathology resolved.¹⁶ Early complications were more common than late complications, with peristomal dermatitis being the most frequent, followed by stoma retraction and necrosis.¹⁷ Emergency surgeries were associated with a higher rate of complications compared to elective procedures, likely due to poor nutritional status, contamination, and hemodynamic instability at presentation.^18,19 Loop ileostomies demonstrated a higher complication rate compared to colostomies, particularly high-output stoma and skin excoriation. Jejunostomies were associated with high-output complications, whereas end colostomies were more prone to necrosis and stenosis. Most complications were managed conservatively with appropriate stoma care and topical therapy. Surgical revision was required in selected cases, such as severe retraction or parastomal hernia. Patients with comorbidities, obesity, or prior abdominal surgery were at higher risk of complications and longer hospital stay, findings consistent with previous clinical studies. The mortality rate of 7% observed in this study was primarily associated with emergency laparotomies and underlying comorbid conditions [Table 12].²⁰

LIMITATIONS

This study has certain limitations that should be acknowledged. Being a single-center, tertiary care hospital-based study, the findings may not be fully generalizable to the broader population or to primary and secondary care settings. The sample size was relatively limited, and the majority of cases were emergency procedures, which may have influenced the pattern and frequency of complications observed. Long-term outcomes beyond 24 weeks, including late complications and quality-of-life parameters, were not assessed. Additionally, variations in surgical expertise, perioperative care, and patient compliance with stoma care could not be uniformly controlled and may have affected the results.

CONCLUSION

Intestinal stomas remain a cornerstone in the surgical management of bowel obstruction, perforation, peritonitis, trauma, and colorectal malignancy. Although lifesaving, stoma-related complications are frequent and can significantly impact a patient’s quality of life. Proper preoperative planning, meticulous surgical technique, appropriate stoma site marking, and early involvement of enterostomal therapy services are essential to reduce morbidity. Anticipation, prevention, and early management of complications contribute substantially to improved functional and psychological outcomes. Future directions include refinement of minimally invasive techniques, improved ostomy appliances, and greater emphasis on patient-reported outcome measures. Ultimately, multidisciplinary collaboration remains critical for optimal long-term rehabilitation of stoma patients.