Permanent stomas

Permanent stomas are necessary if either:

• there is no remaining segment of distal bowel remaining after resection, or,
• the bowel cannot be rejoined for some reason after a temporary stoma was formed

Some circumstances when a permanent stoma is formed are:

• when a colostomy is formed after an abdomino-perineal resection for a low rectal or anal canal tumour
• when an ileostomy is formed after a panproctocolectomy - excision of the whole colon and rectum - unless a pelvic reservoir is formed

These procedures may be performed in conditions such as inflammatory bowel disease or familial polyposis coli.

Permanent stomas are generally situated below the belt line in order to facilitate long-term management. Permanent ileostomies are situated in the right iliac fossa and permanent colostomies are situated in the left iliac fossa.

Note that ileostomies have a protruding spout. This is fashioned in order to allow the ileal effluent containing proteolytic enzymes to drain directly into the appliance bag without eroding the skin.