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Similar to intestinal stomas 07OCT22.pptx
intestinal stomas 07OCT22.pptx
- 1. Lecture by MA J® DR. MUHAMMAD AFZAL CHAUDHARY MBBS (Dow). FCPS (Gen Surgery) Consultant Gen & Laparoscopic Surgeon
- 2. DEFINITION are surgically createdopenings of small or large intestines onto the anterior abdominal wall.
- 3. PRINCIPLES OF STOMAFORMATION _ • Mark the best site for a stoma. • Area should be easy to see and access. • Avoid bony prominences
- 4. 1- ILEOSTOMY • opening2 fingertips in anterior abdominal wall. • Deliver l through the rectus abdominis. • secure to skin
- 5. EFFLUENT Liquid. Discharge almostcontinuously Excoriates & digests skin .Elevate the ileostomy opening 2-3 cm from skin Ileum is everted on itself to form a spout.
- 7. 2-Colostomy Colostomy effluent- • Formedfaeces. • Discharged intermittently. • Not directly corrosive to skin. • Usually falls directly into stoma bag.
- 8. Colostomies are suturedflush with skin. • Allowed to pout slightly to prevent retraction
- 10. End ileostomy • Usuallya permanent stoma IBD FAP COII
- 11. End ileostomy DONE INemergency setting Subtotal colectomy with end ileostomy- • in fulminant or perforated UC • distal LBO • segmental resection WITH primary anastomosis unsafe. e.g.CD
- 12. END STOMAS -End ileostomy • In temporary end ileostomy: 1 End ileostomy (black arrow) and mucus fistula (red arrow).
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- 14. End colostomy APR forCRC • a permanent end colostomy • an elective surgery
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- 16. End colostomy Hartmann’s procedure •In emergency setting. • For ischaemia, perforation or obstruction of distal colon or rectum. • Potentially reversible 3-4 months later. • Patients are often elderly & frail. 40% never undergo reversal.
- 17. Distended coton Obstructing Ulmer msigmoid colon < Temporary colostomy V with rectal pouch (Hartmanns) F'.or ostomy Hi Co'orecta’ aoastamosis
- 18. LOOP STOMAS • • Mostcommon in terminal ileum, transverse colon & sigmoid colon. • A loop of bowel is brought to the anterior abdominal wall & held in place by a plastic bridge passed through the mesentery.
- 19. LOOP STOMAS • Ingeneral, temporary stomas. • Can be reversed via the stoma site 2-3 months after formation. • Used to divert faecal stream to protect - ► a distal anastomosis after low anterior resection. ► Difficult anal sphincter repairs. ► Complex perianal fistula procedures.
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- 22. Attachment of thestoma appliance • Gently clean the stoma & peristomal skin. • Dry the peristomal skin & apply filling paste on it. • Cut the central hole of the skin barrier to match the diameter of the stoma.
- 23. Attachment of thestoma appliance • Remove the sticker of the skin barrier. • Fix the skin barrier to the peristomal skin.
- 24. Attachment of thestoma appliance • Fix the pouch to the skin barrier. • Clip the other end of the pouch. • Finally apply plaster around the skin barrier. POUCH
- 25. Attachment of thestoma appliance
- 26. Complications Early Late 1. Ischaemia1. Stenosis 2. Retraction 2. Prolapse 3. Parastomal herniation 4. Obstruction of small bowel 5. Haemorrhage 6. Diversion colitis 7. Dermatitis 8. Psychological
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- 36. Dietary advice • Takelow fibre food to reduce bulk in stool & help prevent intestinal obstruction. • • Avoid vegetables known to result in offensive odour • . • xRaddish xCabbage • xGarlic xCucumber
- 37. Dietary advice To reduceflatus, avoid: • carbonated beverages • chewing gum x smoking • Chew food well. • Drink adequate amounts of water.
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