Surgical creation of intestinal stoma remains one of the most important and life-saving interventions in general surgery, employed in a wide spectrum of elective and emergency clinical scenarios. An intestinal stoma is an artificially created opening of the intestine onto the anterior abdominal wall, allowing diversion of fecal contents either temporarily or permanently, depending on the underlying pathology and surgical intent.[1] Intestinal stomas are broadly classified based on the segment of bowel used, the anatomical configuration, and the intended duration. According to the intestinal segment involved, stomas may be categorized as small bowel stomas—such as jejunostomy and ileostomy—or large bowel stomas, including ascending, transverse, descending, and sigmoid colostomies. Anatomically, stomas may be fashioned as end stomas, loop stomas, or double-barrel stomas. End stomas involve transection of the bowel with exteriorization of the proximal segment, whereas loop stomas are created without bowel division and are commonly used for temporary fecal diversion. Double-barrel stomas involve exteriorization of both proximal and distal bowel ends.[4] The choice of stoma type is dictated by disease pathology, patient condition, surgical urgency, and the need for distal bowel protection. Management of stoma-related complications varies depending on the type, severity, and timing of the complication. Most early complications, such as skin irritation, mild retraction, and mucocutaneous separation, can be managed conservatively with meticulous stoma care, appropriate appliance fitting, skin protection measures, and nutritional optimization.[15] Medical management may be required for high-output stomas, including fluid resuscitation, electrolyte correction, and antidiarrheal agents. Surgical intervention is reserved for severe complications such as extensive necrosis, persistent retraction, parastomal hernia with obstruction, or prolapse refractory to conservative measures.[16] The present study aimed to evaluate the spectrum of complications associated with various types of intestinal stomas and to assess the methods employed in their management in patients treated at a tertiary care teaching hospital.

Study Design – A prospective observational study Study Setting - Department of General Surgery, S.C.B. Medical College and Hospital, Cuttack, Odisha Study Duration - January 2024 to December 2025 Study Population - all age groups and both sexes who underwent intestinal stoma creation or presented with a functioning intestinal stoma during the study period. Sample Size - 422 patients Sampling Method - A consecutive sampling technique was employed. All patients meeting the inclusion criteria during the study period were included to minimize selection bias. Inclusion Criteria • Patients fulfilling the following criteria were included in the study: • Patients of all age groups and both sexes • Patients undergoing creation of an intestinal stoma (ileostomy, colostomy, or jejunostomy) • Patients presenting with an already created intestinal stoma in the postoperative period • Patients who survived beyond the first postoperative week after stoma creation • Patients with a functioning stoma and available for follow-up from 3 months up to 2 years • Patients willing to participate in the study and who provided written informed consent Exclusion Criteria • The following patients were excluded from the study: • Patients who expired within the first week following stoma creation • Patients unwilling to give informed consent • Patients lost to follow-up before adequate assessment of outcomes Study Procedure - Eligible patients were enrolled after obtaining written informed consent. Stoma creation was performed according to standard surgical principles, with the type of stoma (ileostomy, colostomy, or jejunostomy) and configuration (loop, end, or double-barrel) determined by the underlying pathology and intraoperative findings. All patients received standard perioperative care as per institutional protocols. Postoperatively, patients were monitored for the development of early complications occurring within 30 days of surgery. Patients were subsequently followed up in outpatient clinics or during hospital admissions for the occurrence of late complications beyond 30 days. Data Collection - Data were collected using a pre-designed and pre-tested proforma. The proforma included demographic details, clinical presentation, indication for stoma, type and category of stoma, emergency or elective nature of surgery, associated comorbidities, and postoperative course. Details of early and late complications, stoma care quality, and management strategies were meticulously recorded. Classification of Complications Stoma-related complications were classified as: Early complications: occurring within 30 days of surgery, including peristomal skin irritation, stoma necrosis, mucocutaneous separation, stoma retraction, bowel obstruction, and ileostomy diarrhoea. Late complications: occurring after 30 days, including parastomal hernia, stoma prolapse, stenosis, and chronic retraction. Outcome Measures The primary outcome measure was the frequency and pattern of early and late stoma-related complications. Secondary outcome measures included the type of management required for complications, patient recovery status, and overall outcome categorized as recovered, improved, or persistent complication. Data Entry and Analysis Collected data were entered into a Microsoft Excel spreadsheet and subsequently analyzed using JAMOVI version 2.6.44. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized using mean and standard deviation. Association between stoma-related complications and various clinical variables was assessed using suitable statistical tests, with a p-value of less than 0.05 considered statistically significant.

Table 1: Age distribution Descriptives Descriptives Type of Stoma Age Mean Colostomy 46.2 Ileostomy 49.1 Jejunostomy 56.3 Std. error mean Colostomy 1.35 Ileostomy 1.18 Jejunostomy 4 Standard deviation Colostomy 17.7 Ileostomy 18.1 Jejunostomy 16 Variance Colostomy 312 Ileostomy 327 Jejunostomy 256 The descriptive analysis of age distribution across different types of intestinal stomas demonstrated a clear gradation, with patients undergoing jejunostomy being the oldest (mean age 56.3 years), followed by ileostomy (49.1 years) and colostomy (46.2 years). The relatively higher mean age observed in the jejunostomy group suggests that this procedure was more frequently performed in older patients, possibly reflecting more severe or complex underlying pathology necessitating proximal diversion. The standard deviations for colostomy (17.7 years), ileostomy (18.1 years), and jejunostomy (16 years) indicate a wide age spread across all groups, reflecting the heterogeneous nature of stoma indications. The larger standard error of the mean seen in the jejunostomy group (4 years) compared to colostomy (1.35 years) and ileostomy (1.18 years) suggests a smaller sample size for jejunostomy, which is consistent with its relatively infrequent use in routine surgical practice. Table 2: Indication Indication TypeofStoma Frequency %ofTotal IBD Colostomy 20 4.70% Ileostomy 13 3.10% Jejunostomy 1 0.20% Intestinal obstruction Colostomy 41 9.70% Ileostomy 68 16.10% Jejunostomy 3 0.70% Malignancy Colostomy 41 9.70% Ileostomy 54 12.80% Jejunostomy 4 0.90% Perforation Colostomy 41 9.70% Ileostomy 55 13.00% Jejunostomy 3 0.70% Trauma Colostomy 29 6.90% Ileostomy 44 10.40% Jejunostomy 5 1.20% The distribution of indications for intestinal stoma formation in the present study demonstrated that intestinal obstruction was the most common indication, particularly for ileostomy (16.1%), followed by perforation (13.0%) and malignancy (12.8%), whereas colostomies were most frequently performed for intestinal obstruction, malignancy, and perforation in equal proportions (each 9.7%). Trauma accounted for a notable proportion of stomas, with ileostomy (10.4%) being more common than colostomy (6.9%), reflecting the need for proximal diversion in contaminated or unstable abdominal conditions. Inflammatory bowel disease (IBD) constituted a smaller proportion of indications overall, with colostomy (4.7%) being slightly more frequent than ileostomy (3.1%), suggesting selective stoma choice based on disease extent and patient factors. Jejunostomy was rarely performed across all indications, emphasizing its restricted use in specific high-risk scenarios. The distribution of intestinal stoma creation according to surgical setting demonstrated a clear predominance of emergency procedures, with emergency ileostomy accounting for the highest proportion (38.6%), followed by emergency colostomy (24.6%) and emergency jejunostomy (2.4%). In contrast, elective procedures were less frequent overall, with elective ileostomy (16.8%) and elective colostomy (16.1%) contributing nearly equal proportions, while elective jejunostomy (1.4%) remained uncommon. These findings indicate that the majority of stomas in the present study were created under emergency circumstances, reflecting acute presentations such as obstruction, perforation, trauma, and advanced malignancy. The higherfrequency of ileostomy in emergency settings suggests a surgical preference for proximaldiversion in unstable or contaminated operative fields, whereas colostomies were relatively more evenly distributed between emergency and elective contexts. Jejunostomy remained rare in both settings, underscoring its selective use in complex clinical scenarios. Table 9: TypeEarlyComplication TypeEarlyComplication TypeofStoma Frequency %ofTotal Diarrhea Colostomy 6 1.40% Ileostomy 15 3.60% Jejunostomy 0 0.00% Mucocutaneous separation Colostomy 9 2.10% Ileostomy 20 4.70% Jejunostomy 0 0.00% Necrosis Colostomy 15 3.60% Ileostomy 12 2.80% Jejunostomy 2 0.50% None Colostomy 115 27.30% Ileostomy 151 35.80% Jejunostomy 9 2.10% Retraction Colostomy 15 3.60% Ileostomy 17 4.00% Jejunostomy 3 0.70% Skin irritation Colostomy 12 2.80% Ileostomy 19 4.50% Jejunostomy 2 0.50% Analysis of the type of early complications according to stoma type showed that the majority of patients across all stoma categories experienced no early complications, with ileostomy without complications accounting for the highest proportion (35.8%), followed by colostomy (27.3%) and jejunostomy (2.1%). Among those who developed early complications, mucocutaneous separation and skin irritation were more frequent in ileostomy patients (4.7% and 4.5%, respectively) compared to colostomy (2.1% and 2.8%), reflecting the greater vulnerability of peristomal skin to liquid, enzymerich effluent. Diarrhea was observed predominantly in ileostomy patients (3.6%) and was uncommon in colostomy (1.4%), while absent in jejunostomy, likely due to small numbers. Stoma necrosis was noted in both colostomy (3.6%) and ileostomy (2.8%), with a small contribution from jejunostomy (0.5%), indicating ischemic complications across stoma types. Stoma retraction occurred slightly more frequently in ileostomy (4.0%) than colostomy (3.6%), with jejunostomy again contributing minimally (0.7%). Table 4: TypeLateComplication TypeofStoma Frequency %ofTotal None Colostomy 112 26.50% Ileostomy 159 37.70% Jejunostomy 13 3.10% Parastomal hernia Colostomy 7 1.70% Ileostomy 23 5.50% Jejunostomy 2 0.50% Prolapse Colostomy 20 4.70% Ileostomy 19 4.50% Jejunostomy 1 0.20% Retraction Colostomy 14 3.30% Ileostomy 14 3.30% Jejunostomy 0 0.00% Stenosis Colostomy 19 4.50% Ileostomy 19 4.50% Jejunostomy 0 0.00% Analysis of the types of late complications across different intestinal stomas showed that the majority of patients remained free of late complications, with ileostomy without late complications being most frequent (37.7%), followed by colostomy (26.5%) and jejunostomy (3.1%). Among those who developed late complications, parastomal hernia was the most common, particularly in ileostomy patients (5.5%) compared to colostomy (1.7%) and jejunostomy (0.5%), indicating a higher longterm mechanical burden associated with ileostomy. Stoma prolapse occurred with similar frequency in colostomy (4.7%) and ileostomy (4.5%), while jejunostomy contributed minimally (0.2%). Stoma retraction and stenosis were observed equally in colostomy and ileostomy patients (3.3% and 4.5%, respectively), suggesting comparable longterm risks related to stoma fixation and maturation techniques. Jejunostomy showed very low absolute numbers of late complications, reflecting its limited use and selective indications. Table 5: Management of Stoma Complication ManagementofStomaComplication ManagementofStomaComplication TypeofStoma Frequency %ofTotal Appliance modification Colostomy 43 10.20% Ileostomy 66 15.60% Jejunostomy 5 1.20% Conservative Colostomy 50 11.80% Ileostomy 57 13.50% Jejunostomy 8 1.90% Medical Colostomy 34 8.10% Ileostomy 62 14.70% Jejunostomy 2 0.50% Surgical Colostomy 45 10.70% Ileostomy 49 11.60% Jejunostomy 1 0.20% The distribution of management strategies for stomarelated complications demonstrated that nonsurgical approaches predominated across all stoma types, with appliance modification and conservative management forming the largest share, particularly among ileostomy patients (15.6% and 13.5%, respectively), followed by colostomy (10.2% and 11.8%). Medical management—including treatment of skin complications, infection, dehydration, and electrolyte imbalance—was also more frequently required in ileostomy patients (14.7%) compared to colostomy (8.1%), reflecting the physiological challenges associated with small bowel stomas. Surgical intervention, although less common overall, was required in a notable proportion of both ileostomy (11.6%) and colostomy (10.7%) patients, indicating that a subset of complications was severe or refractory to conservative measures. Jejunostomy contributed minimally across all management categories, consistent with its selective use and smaller patient numbers. Table 6: Outcome Outcome TypeofStoma Frequency %ofTotal Improved Colostomy 59 14.00% Ileostomy 78 18.50% Jejunostomy 7 1.70% Persistent complication Colostomy 50 11.80% Ileostomy 58 13.70% Jejunostomy 2 0.50% Recovered Colostomy 63 14.90% Ileostomy 98 23.20% Jejunostomy 7 1.70% The outcome analysis demonstrated that the majority of patients across all stoma types experienced a favorable clinical course, with the highest proportion achieving recovery, particularly among ileostomy patients (23.2%), followed by colostomy (14.9%) and jejunostomy (1.7%). A substantial proportion of patients also showed clinical improvement without complete resolution, again most commonly in ileostomy (18.5%) and colostomy (14.0%). However, persistent complications were noted in a notable subset of patients, particularly among ileostomy (13.7%) and colostomy (11.8%), while jejunostomy contributed minimally (0.5%). These findings indicate that although most patients benefited from appropriate management of stomarelated complications, ileostomy patients exhibited both the highest rates of recovery and the highest burden of persistent complications, reflecting the dual nature of ileostomy as an effective but physiologically demanding form of diversion. Table 7: Comparison of Mean Age across Types of Stoma (One-Way ANOVA) Test F value p.value Interpretation One-way ANOVA 3.023 0.0497 Statistically significant The one-way ANOVA demonstrated a statistically significant difference in mean age across the different types of intestinal stomas (F = 3.023, p = 0.0497). This indicates that age varied significantly by stoma type, suggesting that patient age influenced the selection or necessity of a particular stoma. Clinically, this finding supports the observation that certain stomas—especially more proximal diversions—tend to be performed in relatively older patients, likely reflecting differences in disease severity, emergency presentation, and physiological reserve.

Jejunostomy patients had the highest mean age, followed by ileostomy and colostomy patients, indicating a trend toward proximal stoma creation in older individuals. Age variability was substantial across all stoma types, highlighting the wide spectrum of clinical indications. The relatively low standard errors for colostomy and ileostomy suggest stable estimates, whereas the higher standard error for jejunostomy reflects limited case numbers. These findings suggest that age may influence both the type of stoma created and the underlying disease severity in patients undergoing intestinal diversion. Ileostomy emerged as the most frequently performed stoma in both males and females, followed by colostomy, with jejunostomy being relatively rare. The distribution of colostomies was identical between genders, while ileostomies showed a marginal female predominance. End stomas were the most commonly constructed configuration, particularly end ileostomies and end colostomies, followed by loop stomas, with doublebarrel stomas being the least frequent. Loop stomas were more often associated with ileostomy and colostomy than jejunostomy, reflecting their role as temporary diversions. Intestinal obstruction emerged as the leading indication for stoma formation, followed by perforation, malignancy, and trauma, with inflammatory bowel disease contributing a smaller proportion. Ileostomy was the most commonly performed stoma across nearly all indications, particularly in emergency conditions, while colostomy was more frequently used in malignancy and distal bowel pathology. Jejunostomy was infrequently required, underscoring its limited and selective role. Emergency surgeries accounted for a substantially higher proportion of intestinal stoma creation compared to elective procedures. Ileostomy was the most commonly performed stoma in emergency settings, followed by colostomy, while jejunostomy was infrequently required. Elective stoma creation showed a more balanced distribution between ileostomy and colostomy. Most patients across all stoma types did not experience early postoperative complications; however, early complications were more frequently observed in ileostomy compared to colostomy and jejunostomy. Ileostomy accounted for the largest share of early complications, highlighting its higher early morbidity profile. Colostomy showed a comparatively lower incidence of early complications, while jejunostomy remained rare but was associated with notable early morbidity in selected cases. Most patients did not experience early postoperative complications; however, when complications occurred, they were more frequent in ileostomy compared to colostomy and jejunostomy. Skinrelated complications, including mucocutaneous separation and skin irritation, were the most common early events, particularly in ileostomy patients, while diarrhea was also more prevalent in this group. Necrosis and retraction were observed across all stoma types but were relatively less frequent. These findings highlight the higher early morbidity associated with ileostomy and the relative stability of colostomy in the early postoperative period. Most patients across all stoma types remained free of late postoperative complications; however, ileostomy was associated with the highest proportion of late complications, followed by colostomy, while jejunostomy contributed minimally. Most patients across all stoma types did not develop late complications; however, among those affected, parastomal hernia emerged as the most common late complication, especially following ileostomy. Prolapse, retraction, and stenosis were observed in both colostomy and ileostomy with comparable frequencies, while jejunostomy contributed minimally to late morbidity. These findings indicate that ileostomy carries a relatively higher risk of late structural complications, underscoring the importance of longterm surveillance and appropriate stoma care. The majority of stomarelated complications were managed without surgery, with appliance change, conservative treatment, and local care forming the cornerstone of management across all stoma types. Ileostomy patients required these interventions more frequently and also accounted for the highest proportion of reoperations. Colostomy complications were more often managed conservatively, while jejunostomy required intervention infrequently. Most stomarelated complications were managed without surgery, with appliance modification, conservative care, and medical management being the most commonly employed strategies, particularly in ileostomy patients. Surgical intervention was required in a smaller but clinically significant subset, more frequently in ileostomy and colostomy than jejunostomy. Most patients demonstrated favorable outcomes following stoma creation and subsequent management, with recovery being most frequent in ileostomy patients, followed by colostomy. A smaller but clinically relevant proportion of patients experienced persistent complications, predominantly among ileostomy and colostomy groups.

The present study concludes that intestinal stoma creation is most commonly performed in emergency settings, with ileostomy being the predominant stoma type, and is associated with a higher burden of both early and late complications compared to colostomy. While the majority of patients did not develop complications and achieved favorable outcomes with appropriate management, ileostomy patients experienced higher rates of skin-related problems, highout-putrelated issues, and structural complications such as parastomal hernia. Importantly, age was the only variable that showed a statistically significant association with stoma type, indicating that patient age plays a role in stoma selection, likely reflecting disease severity and physiological reserve. Most stomarelated complications were effectively managed using conservative, appliancebased, and medical approaches, with surgical intervention required only in a minority of cases. The absence of statistically significant associations between stoma type and complications or outcomes underscores the effectiveness of standardized stoma care and stepwise management protocols. Overall, the study emphasizes the importance of early identification of complications, structured stoma care education, and regular follow-up, particularly for ileostomy patients, to optimize outcomes. These findings reinforce that with appropriate perioperative planning and multidisciplinary care, most patients with intestinal stomas can achieve satisfactory clinical recovery despite the inherent risks associated with stoma formation.

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