Introduction

An intestinal stoma is an opening made in your child's abdomen that empties poo from their bowel to empty into a pouch or bag.

To make a stoma, surgery is done to bring the end of the bowel through a cut in the abdomen. The bowel is stitched to the skin outside the body and the abdominal wall inside the body.

The procedure to make an intestinal stoma will depend on which part of the intestine is used.

  • colonostomy – an opening in the large bowel, or colon
  • ileostomy – an opening in the small bowel, or ileum
  • jejunostomy – an opening in the early part of the bowel, or jejunum.

The stoma is pink, moist, and circular. It should not cause any pain.

A stoma is used to let the digestive system rest during:

  • recovery from physical trauma
  • cancer treatment
  • recovery from removing parts of the bowel
  • treatment of diseases like Crohn's.

Most stomas are temporary. This means they can be closed once your child is well again.

 Before the procedure

The hospital will give you information on preparing your child for the procedure. 

This will include information like:

  • when to stop eating and drinking
  • what time to arrive
  • how long your child will stay in hospital
  • what to bring with you.
  • Make sure you ask your child's treatment team any questions you may have about the procedure and recovery.

Let the hospital know as soon as possible if your child shows signs of illness like fever or breathing difficulties. 

Surgery may need to be rescheduled if your child is unwell.

 During the procedure

The operation is done under a general anaesthetic. This means your child will be asleep during the surgery.

Generally, the steps of the stoma closure procedure are:

  1. the surgeon injects a local anaesthetic to numb the area around the stoma
  2. a cut is made around the edge of the stoma to separate the bowel opening from the skin and the muscle of the abdominal wall
  3. any tissue that is connecting the loops of the bowel will be released
  4. the two ends of the bowel are trimmed and then stitched back together
  5. the bowel is placed back inside the abdomen
  6. the hole in the skin and abdominal wall muscle is closed with stitches.

The procedure will take 1.5 – 3 hours.

The surgeon will usually use stitches that sit under the skin and eventually dissolve. Your child will have a scar on their stomach where the stoma was. 

The scar will grow as your child develops and will fade but may not completely disappear.

 After the procedure

After the operation, your child will stay in the hospital. A nurse will regularly check on the wound and give pain relief medicine through an intravenous (IV) cannula in your child's arm.

Your child can slowly return to eating and drinking once their doctor says it is okay. This can take 24 – 72 hours.

Start with clear fluids, including:

  • breastmilk
  • water
  • gastrolyte
  • jelly
  • soup.

Your child may also be able to have small amounts of full fluids, including:

  • formula - babies under 12 months
  • cow's milk - children over 12 months.

Your child can slowly move on to solid food, depending on their age and how well they are recovering.

Some children can vomit after the procedure. If your child is unwell after the procedure, Your child will be given some fluids through their IV cannula till they resume adequate feeds.

Your child will be in the hospital for around 4-5 days if there are no issues with their recovery. 

Your child's medical team will make a follow-up appointment for you to see the surgeon before you leave the hospital.

 Management

Wound healing

You will be given instructions for looking after your child’s wound when they are discharged from the hospital.

General wound care tips include:

  • keeping the wound dry and clean to prevent infection
  • dry non-adhesive dressings should be changed after every shower or bath
  • adhesive dressings can stay in place for a week.

It is important to inspect your child’s stoma wound daily at home. 

Make sure you look for signs of infection, including:

  • increased pain or swelling 
  • redness around the wound
  • discharge of fluid or pus from the wound
  • fever.

See your local doctor or contact the surgical team if you are concerned about managing your child’s wound.

Bowel movements and rashes

Your child will have frequent and loose poos as their digestive system gets used to working normally again. Rashes around the anus after the stoma closure procedure are common and can be severe if not taken care of. 

Rashes can be managed by:

  • quickly changing the nappy as soon as your child does a poo
  • cleaning with warm, soapy water or sorbolene cream instead of baby wipes
  • not rubbing the area or using products with harsh ingredients, like fragrance
  • using a barrier or nappy rash cream 
  • having nappy free time at home.

Your child's skin will eventually settle as their poo happens less often and become firmer.

Complications of stoma closure

Vomiting

Your child will be given fluids and medicine for pain, nausea, and vomiting. They will need to stop eating until the vomiting settles.

Some children may need a nasogastric or NG tube placed down the nose to drain their stomachs. If the vomiting does not settle, let your child's doctor know as soon as possible.

Wound infection

Because the stoma has contact with poo, the wound may become infected. Your child will be given antibiotics during the operation to lower the risk.

If the wound becomes infected, your child will be given more antibiotics, and the wound might need to be drained.

Bleeding

Bleeding is uncommon, but your child will be watched closely to make sure there are no signs of blood.

Anastomotic leak

An anastomotic leak is a leak that forms where the bowel has been joined back together. Children who develop an anastomotic leak may need surgery to: 

  • redo the joint in the bowel
  • create a new stoma.

A leak can also cause infections that need to be treated with antibiotics.

Bowel obstruction

Bands of scar tissue called adhesions can form around the bowel. This can cause a blockage or obstruction, which can be fixed with surgery. 

Bowel obstruction can happen at any time, but the risk is highest in the weeks after the procedure to close a stoma.

Signs of a bowel obstruction are usually around the stomach area and include:

  • severe pain and cramps
  • gas
  • bloating
  • constipation
  • vomiting.

If your child's vomit is a green colour, call triple zero (000) for an ambulance or go to your nearest emergency department. Green vomit is called bilious vomit and is a sign of a twisted or blocked bowel.

Incisional hernia

Weak spots can develop in the muscles where a cut or incision was made during surgery. When there is a muscle weakness, your child's organs may push or bulge through. This is called an incisional hernia.

Incisional hernias are rare and need to be repaired with surgery.

When to see your doctor

Call your local doctor or your child’s surgeon if they have issues, including:

  • breathing difficulties
  • poor feeding, high temperature
  • nausea and vomiting 
  • loss of appetite
  • worsening nappy rash or diarrhoea
  • difficulty passing urine
  • pus or poo leaking from the wound.

If your child’s vomit is a green colour, call triple zero (000) for an ambulance or go to your nearest emergency department. 

Green vomit is called bilious vomit and is a sign of a twisted or blocked bowel.

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024