Stoma formation is a commonly performed procedure in colorectal surgery as a part of operations performed for malignant- and inflammatory bowel disease. Stoma formation is a simple, but not trivial, undertaking. When performed badly, it can leave the patients with a legacy of complications such as leakage, prolapse, parastomal hernia and retraction. Various studies have reported a complication rate of 21-70%. We performed a literature search using the Medline, Ovid and Google scholar database for all the articles published between January 1980 and December 2008. The search terms used were colostomy, ileostomy, stoma, parastomal hernia, stenosis, prolapse, necrosis and complications. The following article summarizes the common complications associated with stomas.

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Ali patients presenting with acute upper gastrointestinal bleeding between November 1986 and April 1988 were admitted to a centralised joint medical/surgical unit, with a policy of early clinical and endoscopic assessment and rapid surgical intervention in those at high risk. Of the 430 patients admitted 69*5% were over the age of60 and 30% had significant additional medical conditions. 50 4% were bleeding from peptic ulcers and one third had been taking non-steroidal anti-inflammatory agents. Fifty five patients underwent surgery, which in two thirds was carried out within 24 hours of admission, usually for continued bleeding. In patients with peptic ulcer the operation rate was 21*6%. Overall mortality was 3*7%, and in those with bleeding gastric or duodenal ulcers 5-5%; surgical mortality in the later group was 15-2%. All patients who died had serious concomitant pathology and 87% were over 70 years of age. Adoption of a centralised approach to management ofhaematemasis and melaena is feasible in a District General Hospital and associated with an improved survival.

Ten cases of secondary arterio-enteric fistulae are described. There were nine graft enteric fistulae and one fistula involving the aortic suture line following elective resection of an infected graft. Only four of the patients initially received prophylactic antibiotics (single dose) at the original aortic reconstruction, and the vascular suture line had only been protected in two. Eight patients presented with bleeding and two with groin abscesses. One patient died before operation. Graft resection was undertaken in all patients and organisms were grown from six of eight grafts cultured. No patient died during operation but one died after 3 days. Axillofemoral bypass grafts were constructed in seven patients (four immediately after resection of prosthetic grafts and three within 4 days of operation). Only three of the eight patients who survived operation are still alive; two died of a ruptured aorta and one from a recurrent fistula. Two patients died of other causes. Four of five axillofemoral grafts in surviving patients subsequently occluded.

Organized lymphoid tissue in the rat colon exists as clusters (colonic lymphoid patches) of intramucosal and submucosal follicles in the proximal, mid, and distal colon, interspersed by solitary follicles. The follicular lymphoid cells of colonic lymphoid patches are separated from the gut lumen by a highly specialized lymphoepithelium which lacks mature goblet cells. Cells of this epithelium are of two types: those characterized by an electron-dense cytoplasm, large numbers of apical vesicles and lysosomes, and prolonged extensions of the apical cytoplasm forming thin partitions between the gut lumen and underlying intercellular spaces; and cells with a less electron-dense cytoplasm, distorted mitochondria, and little endoplasmic reticulum. Both cell types bear normal microvilli and have numerous lateral membrane processes which penetrate large intercellular spaces. A ferritin-India ink label infused into the colonic lumen was preferentialfy adsorbed onto the surface of this follicle-associated epithelium. Indigenous colonic bacteria were observed penetrating the superficial cytoplasm of the electron-dense cells where they were enclosed in lysosomes and digested. An antigen-sampling role is proposed for the colonic lymphoid patch epithelium.