Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Available
3. COLOSTOMY..ppt
1. Dr Phillipo Leo Chalya MD, M.Med (Surg)
Senior Lecturer – Department of Surgery
CUHAS-Bugando
COLOSTOMY
1
2. Leaning objectives
Definition
Indications
Classifications
Colostomy formation
Colostomy care
Colostomy closure
Complications of colostomy and its
closure
Conclusion
2
3. DEFINITION
A colostomy is a surgical procedure that
brings a portion of the large intestine through
the anterior abdominal wall to divert faeces
and flatus to the exterior, where it can be
collected in an external appliance (colostomy
bag)
3
14. CLASSIFICATION
According to the purpose
According to the function
According to the site/location
According to the type of colostomy
According to the nature of operation
14
15. According to the purpose
Temporary colostomy
Permanent colostomy
15
16. Temporary colostomy
Temporary colostomies are created to divert
stool from injured or diseased portions of the
large intestine, allowing rest and healing and
later closed to maintain the bowel continuity
Commonly loop or double barrel colostomies
16
17. Permanent colostomy
Permanent colostomies are performed when the distal
bowel (at the farthest distance) must be removed or is
blocked and inoperable
Permanent colostomy are usually formed after
resection of the rectum for a carcinoma by the
abdominoperineal technique [APR]
They are usually end colostomy
17
18. According to the function
Decompressing colostomy
Defunctioning /diverting colostomy
18
19. Decompressing colostomy
Intended to decompress the colon
It does not completely defunction the bowel as
some faeces can travel into the distal loop
It is inadequate in conditions in which
defunctioning is essential
Example of this is a loop colostomy
19
20. Defunctioning /diverting colostomy
Intended to defunction or to divert the colon i.e.
to prevent faecal material traveling into the
distal segment
In this case the bowel is transected and the
two ends [proximal and distal ends] need to be
separated
Include end , spectacle or double-barrel
colostomy
20
21. According to the site/location
Transverse
colostomy
Sigmoid colostomy
Caecostomy
21
22. According to the type
Loop colostomy
Double – barrel colostomy
End colostomy
Spectacle colostomy
22
23. Loop colostomy
This colostomy is created
by bringing a loop of bowel
through an incision in the
abdominal wall
A loop colostomy is made
by bringing a loop of colon
to the surface, where it is
held in place by a plastic
bridge passed through the
mesentery
23
24. Double – barrel colostomy
The bowel is transected
and the two ends are
brought together through
one incision
The proximal end is the
functional end that is
connected to the upper GI
and will drain stool; the
distal stoma, connected to
the rectum and also called
a mucous fistula, drains
small amounts of mucus
material
24
25. End colostomy
The functioning
proximal end of the
intestine is brought out
onto the surface of the
abdomen, forming the
stoma (colostomy)
The distal portion of
bowel (now connected
only to the rectum) may
be removed, or sutured
closed and left in the
abdomen
25
26. Spectacles colostomy
The proximal and distal limbs are
separated by small bridge of skin
The two limbs are opened
through a separate skin incision
With the introduction of end
colostomy with Hatmann
procedure, spectacles colostomy
is no longer performed
26
27. According to the nature of operation
Emergency colostomy
Elective colostomy
27
29. Principles of colostomy formation
The colostomy site should be selected to avoid fat
folds, scars, umbilicus and bony prominences
The colostomy should be brought through a separate
skin incision and not through a laparotomy incision
Tension on the mesentery should be avoided during
construction of a colostomy i.e. the bowel should be
mobile enough to be brought through the abdominal
wall
29
30. Pre-operative care
Colostomies are created in both elective and
emergency settings
Pre-operative care in involves:-
Counseling
Correction of intercurent infections, anemia and other co-
morbid conditions
Bowel preparation
Pre-anesthetic visit
Signing of a written informed consent
Enterostomal therapist visit
30
31. Counseling
Colostomy is a frightening procedure and exposes the
patient and her/his family to psychosocial trauma
Adequate counseling should be part and parcel of the entire
management strategy to enable the patient and his/her
family to cope with the stress and to adjust their life styles
A physician, enterostomal therapist, or nurse specialist
should counsel the patient undergoing elective colostomy
as well as their families
This psychological preparation reduces their anxiety and
makes postoperative management easier
The patient should be counseled properly on how to live
with a colostomy and how to take care of it
31
32. Correction of associated disease conditions
Intercurent infections [e.g. chest infections,
diarrhoea], anemia and other pre-existing
conditions should be controlled before surgery
32
33. Bowel preparation
Preoperative bowel preparation is important to avoid
colostomy-related complications
This include:-
Mechanical bowel preparation
Enema
Nasogastric tube on the day of operation or intraoperatively to
remove gastric secretions and prevent nausea and vomiting
Dietary management
Low residue diet for several days prior to surgery
A liquid diet may be ordered for at least the day before surgery,
with nothing by mouth after midnight
Pharmacological management
Oral anti-infectives (neomycin, erythromycin, or kanamycin
sulfate) may be ordered to decrease bacteria in the intestine
and help prevent postoperative infection
33
34. Pre-anesthetic visit
This should be done to be able to assess the
patient’s general condition and fitness for
surgery and anesthesia
34
35. Written informed consent
As with any surgical procedure, the patient
will be required to sign a consent form after
the procedure is explained thoroughly
35
36. Enterostomal therapist visit
If possible, the patient should visit an enterostomal
therapist, who will mark an appropriate place on the
abdomen for the stoma and offer preoperative
education on colostomy management
36
38. Post-operative care
Like in any major surgery postoperative care for the patient
with a new colostomy, involves:-
Fluids and electrolytes are infused intravenously until the
patient's diet can gradually be resumed, beginning with liquids
[usually up to 72 hrs]
The nasogastric tube will remain in place, until bowel activity
resumes
For the first 24–48 hours after surgery, the colostomy will drain
bloody mucus
Analgesics to relieve pain
Antibiotics given parenterally
Monitoring of blood pressure, pulse, respirations, and
temperature [vital signs]
A colostomy pouch will generally have been placed on the
patient's abdomen around the stoma during surgery
38
39. COLOSTOMY CARE
Psychological care
Mechanical care
Dietary care
Gas and odor care
Peristomal skin care
Pharmacological care
39
40. Psychological care
Counseling should continue during treatment
and follow up to enable the patient to cope to
their life style
Often, an enterostomal therapist will visit the
patient in the hospital or at home after
discharge to provide counseling and to help
the patient with stoma care
40
41. Mechanical care
Use of colostomy bags [pouches]
Colostomy irrigation [i.e. putting a fluid into the stoma
to empty the bowel]also called colostomy enema
41
42. Dietary care
Dietary counseling is necessary for the patient to
maintain normal bowel function and to avoid
constipation, impaction, and other discomforts
Need to avoid foods that cause gas and odor e.g.
fish, onions, garlic, broccoli, asparagus and cabbage
produce odor
42
43. Gas and odor care
Limit foods such as broccoli, cabbage,onions, fish, and
garlic in diet to help reduce odor
Each time you empty your pouch, carefully clean the
opening of the pouch, both inside and outside, with
toilet paper
Rinse your pouch one or two times daily after you
empty it
Add deodorant (such as Super Banish or Nullo) to your
pouch.
Use air deodorizers in your bathroom
43
44. Care of peristomal skin
Local irritation, skin excoriation, and yeast infections can
be treated with appropriate topical medication and skin
care
Protect skin from effluent using:-
Wafers eg Duoderm, Coloplast
Pastes eg Karaya, Softpaste
Lotions eg Cavilon,Dansac- use as spray or spread
Powders e.g. Orahesive- removes fluid from moist skin
Stoma bags
44
45. Pharmacological care
Once the colostomy has been established
no pharmacological treatment is required
Pharmacological care is reserved in case of
complications e.g. colostomy diarrhoea,
wound infections, constipation etc
45
46. COLOSTOMY CLOSURE
Prerequisites of colostomy closure
Timing of colostomy closure
Preoperative preparation
Types of colostomy closure
Post operative care
46
47. Prerequisites of colostomy closure
The following must be taken into account before
closing a colostomy:-
The original reason for the colostomy
Whether the patient is able to undergo more surgery
Patient’s general condition
The presence of stoma-related complications
Colostomy closure should be performed when the
patient has recovered from original operation, his
general condition is good and his colostomy wound is
healthy
47
48. Timing of colostomy closure
Timing of colostomy closure depends on factors such
as:-
the underlying disease
the general medical condition of the patient
the presence of colostomy-related complications
The state of the colostomy wound
Understanding the anatomy prior to colostomy closure
is crucial
Colostomy closure usually done in 2-6 weeks when
the colostomy wound is healthy and the patient has
recovered from his original operation
48
49. Preoperative preparation
The patient should be prepared as for any other major
surgery
The general condition of the patient and his colostomy
wound should be assessed for fitness to surgery
Enema to his proximal and distal ends for 2-3 days before
surgery to washout his gut
Magnesium sulphate to help empty his proximal gut and
to make sure that the next feces he passes is soft
Neomycin, metranidazole may be given perioperativelly
49
51. Extraperitoneal colostomy closure
Colostomy closure without need to open the
abdomen
It is easy and avoids the risk of contaminating
the peritoneal cavity
Only applied to loop and double-barrel
colostomies
51
52. Intraperitoneal colostomy closure
The colostomy is closed by opening the
peritoneal cavity
Difficulty procedure as laparotomy is needed
in order to close the colostomy
It has high risk of contaminating the
peritoneal cavity
52
55. Skin irritation
Skin irritation and infection are the
most common complications with
colostomy
Excoriation from stoma effluent,
candidal infection and dermatitis
are frequent
Improper location or construction
of the stoma and poor stoma care
are often responsible
Local wound care and patient or
caretaker education often corrects
the problem
55
56. Colostomy necrosis
This is death of the
colostomy tissue
Caused by inadequate
blood supply, this
complication is usually
visible 12–24 hours after
the operation
Usually requires
additional surgery
56
57. Colostomy bleeding
Minor bleeding can occur with overly vigorous stomal
cleansing
Major bleeding from the stoma itself is uncommon and
usually indicates either a stomal laceration from a poorly
fitting appliance or the development of peristomal varices in
the patient with portal hypertension
Initial management of stomal bleeding involves direct
pressure and AgNO3 cauterization or suturing of the
bleeder if required
Definitive management depends upon the etiology of the
bleeding.
57
58. Colostomy prolapse
Both proximal and distal bowel
segments can protrude many
centimeters
Colostomy prolapse commonly
occurs in end or loop colostomies
Most often results from an overly
large opening in the abdominal wall
or inadequate fixation of the bowel
to the abdominal wall
Colostomy prolapse can occur in
patients with elevated
intraabdominal pressure, especially
if there was inadequate fixation of
the bowel to the internal abdominal
wall
Surgical correction is required when
blood supply is compromised and in
case of obstruction, ulceration or
chronic bleeding .
58
59. Colostomy retraction
In this case the colostomy is drawn
back into the abdomen
Caused by insufficient stomal length,
this complication may be managed
by use of special pouching supplies
Retraction of a loop colostomy
results in a blow hole configuration
that allows proximal contents to spill
into the distal segment
Revision may be required if distal
diversion is necessary
Permanent colostomy that have
retracted may require surgical
revision
59
60. Colostomy strictures /stenosis
Colostomy strictures can occur
at the skin and/or fascial levels
Often associated with infection
around the colostomy or
scarring
Mild stenosis can be removed
under local anesthesia
Severe stenosis may require
surgery for reshaping the stoma
Attempts at dilating the
colostomy are usually
unsuccessful and may cause
intestinal perforation
60
61. Parastomal hernia
Protrusion of viscus in the
abdominal wall next to the
colostomy wound
Predisposing factors
Weak abdominal wall
Large stoma aperture
Obesity
Prior abdominal incisions
Malnutrition
Wound infection
Parastomal hernias usually
require surgical intervention
If severe, the defect in the
abdominal wall should be
repaired and the stoma moved to
another location
61
62. Intestinal obstruction
Can occur due to adhesion, volvulus, stricture or internal
hernia
Obstruction is usually obvious and the diagnosis is based on
the patient's history and findings at physical examination and
on plain radiography
In all patients with a bowel obstruction, a nasogastric tube
should be placed for decompression and the patient should
receive intravenous hydration
Prompt surgical exploration is required in patients with
suspected ischemic or gangrenous bowel, clinical
deterioration or obstruction that does not rapidly resolve with
nonsurgical therapy
62
64. CONCLUSION
In the last century, there have been dramatic improvements
in surgical techniques for the creation of colostomy
Life with a colostomy has also changed dramatically
The development of enterostomal therapy and the
improvement of colostomy management systems have made
life with a stoma nearly as routine as life with an anus.
“Care and expertise are important in creating intestinal
stomas because some patients must live with the
technical result for the rest of their lives”.
64
