COLOSTOMY

EMERGENCY OPERATION

1. Definition: Operation that must take within hours even minutes, because of severity of disease life threatening will worsen

increase morbidity

2. Problems

: 1. physiology imbalances: shoch, acidosis, sepsis

2. Correction physiologic abnormalities, impossible before source control

3. Insufficient time for correction.

3. Programes

: 1. Resuscitation programes

1. Restoration blood volume, No patient should go to operating before initial resuscitation ( 1/2D + M ), except in hemorrhagic cases.

~ monitoring of: decreasing pulse, rising of BP, improved cutaneous circulation and urinary output.

( deficit does not need to be completely corrected~ but should be in progress ).

2. Established adequate ventilation.

1. Inserted Nasogastric tube ~ decompressed intra abdominal pressure.

2. O2 supplied

3. Endotracheal tube inserted and assisted ventilation

~ monitoring of Oxygen saturation

3. Corrected acidosis

~ monitoring blood gas analyses

4. Restored electrolyte balance

~ monitoring of : K, Na, Ca, Cl serum

5. Restore clotting component

~ monitoring of : platelet count, PT, PTT

Should be given plattlets, FFP or clotting factor component

6. Controlled of sepsis

~ high dose antibiotic, in most cases are impossible until source control has been performed.

2. Parent programes: not to negleted the family, the parental concern ~ the child will survive

1. Explain what is wrong, what is to be done, appraisal duration of operation ~ relieve parents anxieties.

4. Check Preoperative

1. NGT

2. Adequate Intravenous Catheter

3. Blood Cross Matched

4. Laboratorium Studies : CBC, Electrolytes, Clotting Factor, Blood Gas Analysis

5. X-Rays : Chest

6. Oxygen Saturation Monitoring

7. Operative Permit

COLOSTOMY

Definition

:

An external opening of the colon on the abdominal wall. It is used to divert the fecal stream as an ajunct to reconstructive surgery and in the initial treatment of a variety of diseases of the colon, rectum and anus.

Types of colostomy:

A. Loop colostomy.

Spillover of feces can occur into the distal limb.

B. Divided colostomy.

Created by totally dividing the colonic loop and bringing the end out as two separated stomas.

C. End colostomy.

Bringing only the proximal end up to the skin. The distal end is sutured shut. This tipe can be used only if the distal colon is open through the anus.

Problems

:

a. Bleeding in the first 24 hours is usually from a submocosal vessel and may require suture to control.

b. Prolapse is eversion of the mucosa or full tickness bowel wall. It is common complicatoin with loop colostomy but is rare in end colostomies. Prolapse can be reduced easily if treated promptly, beforeedema develops. If it is mild and occurs infrequently, no treatment is needed. Recurring severe prolapse requiresoperative revision of the stoma. Sometimes, narrowing the stoma by placenent of pursestring suture at the mucocutaneous junction will prevent prolapse.

c. Stomal stricture, sticture can be at the skin or fascial level. Frequent of watery movements or decreased frequency of stools with abdominal distention are sign of stomal stricture. Dilatation may be adequate treatment, but operative revision is frequently necessary

d. Other complications

Procedures:

Site of colostomy:

1. Atresia ani : between umbilical

SIAS

2. Hirschsprungs : leveling colos

tomy, depend of

Radiological

study

3. Other

Maturation

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

EMBED MSPhotoEd.3

_1212528142.bin

_1212528809.bin

_1212529667.bin

_1212530191.bin

_1212530471.bin

_1212529370.bin

_1212528247.bin

_1212527940.bin

_1212528067.bin

_1212527868.bin