Which ostomies are usually the largest?

• A. End stomas and ileostomies
• B. Loop stomas and ileostomies
• C. Loop stomas and colostomies
• D. End stomas and colostomies

Answer: (D)

The size of a stomal opening depends on how the bowel is brought to the surface and which segment is used. End stomas are single openings created by everting the bowel to the skin, and when formed from the colon, the colonic lumen is generally larger than the ileal lumen. This combination—end stoma plus colostomy—tends to produce the largest stoma opening. Loop stomas have a skin bridge and two lumens, which can constrain the surface opening to protect the bowel and skin, so they’re typically smaller. Ileostomies come from the ileum, which has a smaller caliber, also contributing to smaller stomal openings.