PURPOSE：The purpose of this study was to evaluate our procedure for a covering ileostomy after super low anterior resection for rectal cancer,focusing on complications and postoperative management．METHODS：Our procedure for a covering ileostomy after super low anterior resection for rectal cancer is as follows；1)Fixing the exteriorized ileum at four points of the anterior sheath of the rectus abdominis muscle；2)Making a semicircular(perpendicular to the longitudinal axis of the ileum)incision of the fixed ileum along the line deviated to the oral side(about 7：3； oral side：anal side)；3)Performing a buried suture of the intestine with the skin without removing the stitches；4)Using a semi-mattress suture for skin closure of the midline incision near the ileostomy in order to avoid soiling or infection．RESULTS：Our procedure facilitates skin care around the stoma and control fot watery diarrhea,one of the main complications of ileostomy．
There was never any skin infection around the stoma observed．
CONCLUSION：Our procedure resulted in well-shaped ileostomies with few complications,resulting in easy postoperative management．

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The purpose of this study is to evalute the state of the quality of life(QOL)for colostomates and how the QOL relates to their generic health status,anxiety,and depression QOL was assessed with the Ostomates QOL questionnaires(OsQOL)．Short Form 36(SF-36),State Trait Anxiety Inventory(STAI),and Self-Rating Questionnaire for Depression(SRQ-D)．
The subjects were 19 colostomates who underwent abdominoperineal resection and visited our stoma clinics．The mean scores of the OsQOL were higher than the reference mean of the OsQOL committee except“activity”．In contrast,SF-36 scores were below that of the general population．
Regarding the scores of STAI,53％ of colostomates were in a high state of anxiety and 42％ of them generally felt high anxiety．Moreover,32％ of them were in depressive or borderline depressive state．
The“activity”and“psychological state”of OsQOL had significant positive correlations with SF-36 and had significant negative correlations with STAI and SRQ-D．Also,SF-36 had a significant negative correlation with STAI and SRQ-D．These results suggested that a longer follow-up by the stoma clinic is desirable in the management of colostomates and could contribute toward improving QOL．

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A 45-year-old Japanese female underwent total colectomy and terminal ileostomy for intractable colitis with a recto-vaginal fistula．
Peristomal pyoderma gangrenosum developed 1 year after the operation．The stoma revision was performed when she underwent an emergent laparotomy for a strangulation ileus．Although she did not develop any gastrointestinal symptoms,peristomal pyoderma gangrenosum recurred at the new ileostomy site 19 months after the stoma revision．The recurrent peristomal pyoderma gangrenosum healed after amputation of the remnant rectum．Since then,she has not developed peristomal pyoderma gangrenosum for two years．Pyoderma gangrenosum is a rare but debilitating condition that occurs in patients with inflammatory bowel disease．ln contrast,peristomal pyoderma gangrenosum has been recognized only relatively recently,and is much less common．ln this case report,the characteristics and the treatment of peristomal pyoderma gangrenosum for the patient with inflammatory bowel disease are discussed．

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Patients with psoriasis are easily affected by the Koebner phenomenon and the Auspitz phenomenon in the peri-stomal skin areas due to chemical or physical stimuli from urine and skin barriers for stoma care．In this regard,the control of psoriasis is important for achieving successful stoma care．Here we report on a patient with psoriasis who was treated by radical cystectomy with ileal conduit and discuss techniques for stoma care in a patient with psoriasis．

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