intestinal stomas
TRANSCRIPT
Intestinal stoma (basic)
Mohammed T. Doukhi
MD,
Technology Jordan university of Science &
INTESTINAL STOMAS
Definition
Classification
Complication of intestinal stoma
Dietary advice to stomatised patient
DEFINITION
Intestinal stomas are,
Iatroginic Surgically created opening of small or
large intestine on to the anterior abdominal wall.
classification
Intestinal stoma
colostomy ileostomy
classification
Intestinal stoma
END STOMAConsists of a single
intestinal lumen
LOOP STOMA Give access to both
afferent & efferent limbs
classification
INTESTINAL STOMA
PERMANEN
T
TEMPORAR
Y
End vs. loop
End ileostomy
In right iliac fossa • Usually a permanent
stoma
End ileostomy
Usually temporary in the emergency setting
►Subtotal colectomy with end ileostomy- in
fulminant or perforated ulcerative colitis. in
distal obstruction of large bowel where
caecum is non viable or perforated.
►After a segmental resection of small bowel
where primary anastomosis is unsafe. e.g.
perforated Crohn’s disease, thromboembolic
bowel ischamia
End ileostomy
In temporary end ileostomy: Distal bowel
closed & left in abdomen exteriorized as a
mucous
fistula
End ileostomy
In temporary end ileostomy: Relaparotomy to
restore intestinal continuity when the patient
has recovered (after 3-4 months).
Loop ileostomy
Most common 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. • Bowel wall is incised & edges are
sutured to skin. • Plastic bridge is removed
when mucocutaneous anastomosis has
matured (after 5-7 days)
Loop ileostomy
Loop ileostomy
Loop ileostomy
In general, temporary stomas. • Can be
reversed via the stoma site 2-3 months after
formation
Comlication of itestinal stoma
Early
1. high output
2. Ischaemia
3. Retraction
Late
1. Stenosis
2. Prolapse
3. Parastomal herniation
4. Obstruction of small bowel
5. Haemorrhage
6. Diversion colitis
7. Dermatitis
8. Psychological
High output.; Output from the newly
constructed ileostomy is usually high (1–1.5 L)
in the first 2 weeks. The average daily output
from an established ileostomy is 500–800
mL/day. A high-output ileostomy is one that has
an effluent discharge of more than 1 L/day.
Patients with an ileostomy are prone to high-
output diarrhoea, with resultant water and
sodium depletion.
cont,
Ischemia
Retraction
Complete retraction into
peritoneal cavity Peritonitis
Partial retraction
Subcutaneous tissue is
exposed to faecal contents
Peristomal cellulitis,
abscesses & fistulae
Stenosis
Predisposing causes:
►Aponeurotic opening too
small ►Stomal ischaemia
Prolapse
Stomal prolapse
Predisposing factors:
►Aponeurotic opening too
large ►Excessive
mobilization of redundant
bowel ►Raised intra-
abdominal pressure
Parastomal herniation
Parastomal herniation The
most common late
complication . Occurs in up
to 30% of stomas.
Incidence increases with
time
Dermatitis
Contact dermatitis from
occlusive appliances
Allergic responses to
adhesives Fungal &
bacterial infections
Dietary advice to ostomates
• Take low fibre food to reduce bulk in stool &
help prevent intestinal obstruction. • Avoid
vegetables known to result in offensive odour.
×Raddish ×Cabbage ×Garlic ×Cucumber
To reduce flatus, avoid:
× carbonated beverages
× chewing gum
× smoking
• Chew food well
• Drink adequate amounts of water
How to apply stoma
Cont,