Differentials
| Presenting Feature | What might it be? | What might I find? | |
| Bowel Stoma |
Gastrostomy |
Artificial connection between stomach and abdominal wall.
Often created via percutaneous endoscopic insertion (PEG). Commonly used for feeding in patients unable to feed orally. |
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Loop ileostomy |
Temporary connection between proximal and distal ends of small bowel and skin.
Allows post-operative recovery of distal section of bowel after surgery for obstruction, malignancy, inflammatory bowel disease, new anastamosis formation. Usually reversed 6-8 weeks after formation. Drains liquid, watery stool. Dual lumen, functioning (proximal) end may be spouted with a flatter distal end. |
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End ileostomy |
Connection between end section of proximal small bowel and skin.
Formed after panproctocolectomy or emergency subtotal colectomy. Typically in right iliac fossa. Spouted, single lumen. Drains liquid, watery stool. |
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Loop colostomy |
Temporary connection between proximal and distal ends of large bowel and skin.
Allows post-operative recovery of distal section of large bowel after surgery for obstruction, malignancy, inflammatory bowel disease, new anastamosis formation. Usually reversed 6-8 weeks after formation. Drains formed or solid stool. Dual lumen, functioning (proximal) end may be spouted with a flatter distal end. |
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End colostomy |
Connection between end section of proximal large bowel and skin.
Formed after abdomino-perineal resection or Hartmann’s procedure (rectum sewn). Distal colon either left in situ and sutured, or rectum and anus have been removed. Typically in left iliac fossa. Non-spouted, single lumen. Drains formed or solid stool. |
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| Urinary stoma |
Urostomy |
Connection between kidney and skin, bypassing ureters, bladder and urethra.
Formed after cystectomy (e.g., for bladder cancer). Section of ileum used to create ileal conduit, draining urine directly to the stoma. Single lumen, spouted. May be located on either right or left side of abdomen. |
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Checklist
| Preparation | Wash – Name – Explain | |
| Position patient lying at 45° on couch | ||
| Appropriate exposure of the abdomen | ||
| General Inspection | Body habitus | |
| Systemic appearance | ||
| Presence of stoma | ||
| Clues in bed space | ||
| Inspection | Location of stoma | |
| Number of lumens | ||
| Spouted or flush with the skin | ||
| Contents of stoma bag | ||
| Stoma condition | ||
| Presence of complications | ||
| Finishing | Re-cover patient | |
| Wash hands |
Explanation
Preparation
“I have been asked to carry out a stoma examination. This involves looking at the opening and the contents of your stoma. I can stop at any time. Are you happy for me to do that?”
Position the patient reclining on the examination couch at 45°. Ensure that the patient’s abdomen is exposed from xiphisternum to pubic symphysis.
General Inspection
Look at the patient and around the bed space for useful signs:
- Body habitus (e.g., cachexia in malignancy)
- Systemic appearance – do they look well or unwell?
- Presence of stoma – stoma +/- bag will be visible from the end of the bed.
- Clues in bed space (e.g., analgesia, IV fluids, vomit bowls, spare stoma bags)
Does the patient look unwell? A stoma may be created as part of an elective procedure (e.g., planned surgery for bowel cancer), but may also be fashioned in an emergency situation, and the patient may be systemically unwell (e.g., bowel perforation, severe inflammatory bowel disease flare).
Inspection
Inspect the stoma site and note the following:
- Location of stoma – an ileostomy is usually formed in the right iliac fossa, and a colostomy in the left iliac fossa.
- Number of lumens – single lumen (e.g., end colostomy) or dual lumen (e.g., loop ileostomy).
- Spouted or flush with the skin
- Contents of stoma bag – watery stool (e.g., ileostomy), formed stool (e.g., colostomy), or urine (e.g., urostomy).
- Skin condition
- Complications (e.g., parastomal hernia, prolapse, retraction)
Is the stoma spouted or flush with the skin? Stomas producing contents which will irritate the skin (e.g., ileostomy or urostomy) are usually spouted, whereas a colostomy is flush with the skin as the formed stool is less of an irritant.
A dual lumen stoma (e.g., loop ileostomy) will likely have a spouted proximal lumen and a distal lumen that is flush with the skin.
Examine the condition of the skin around the stoma site for any redness, irritation, cellulitis, etc.
Finishing
Thank the patient and allow them to cover themselves. Wash your hands.
Last updated Aug 2025
Head to members.zerotofinals.com for practice OSCE stations, including an interactive checklist, specific cases and clinical findings.
