Stomas Flashcards
Loop Ileostomy
- Site
- Spout
- Contents
- Skin
- Lumens
- Indications
- Site: RIF usually
- Spout: Yes
- Contents: Small bowel contents usually
- Skin: look for excoriation from alkaline small bowel contents
- Lumens: two- the proximal lumen is the active lumen that has small bowel contents coming
out of it - Indications: situations where a primary anastomosis is formed that is deemed to be at risk of a leak, to reduce the risk of a clinically significant leak. For example, in a low anterior resection, especially in patients who have received radiotherapy. The loop ileostomy is brought out to protect the distal anastomosis. Three months postoperatively, the anastomosis is tested by using a dye inserted rectally (a Gastrografin enema) to ensure there is no stricture or leak, and the patient can be brought in for a reversal of ileostomy
Risks of more proximal Stomas
The more proximal the stoma, the higher the stoma output and the greater the risk
of electrolyte abnormalities and dehydration.
End Ileostomy
- Site
- Spout
- Contents
- Skin
- Lumens
- Indications
Stomas that may Resemble an End Ileostomy
Single lumen of ileum brought to the surface.
- Site: RIF usually
- Spout: Yes
- Contents: Small bowel contents usually
- Skin: look for excoriation from alkaline small bowel contents
- Lumens: One
Indications:
- Permanent: Panproctocolectomy (UC, FAP)
- Temporary: Emergency subtotal colectomy
Loop Colostomy
- Site
- Spout
- Contents
- Skin
- Lumens
- Indications
- Site: it may be in the LIF (defunctioning loop sigmoid colostomy) or in the upper abdomen(defunctioning loop transverse colostomy) on the right or left
- Spout: No
- Contents: Faeces
- Skin: usually don’t get excoriation as feces rather than small bowel contents
- Lumens: two- the proximal lumen is the active lumen that has feces coming out of it
Indications: To defunction
- Relieve distal obstruction
- Protect new distal anastomosis
End Colostomy
- Site
- Spout
- Contents
- Skin
- Lumens
- Indications
- Site: LIF
- Spout: No
- Contents: Faeces
- Skin: usually don’t get excoriation as feces rather than small bowel contents
- Lumens: One
Indications:
- Permanent: Abdominoperineal resection
(APR) - Temporary: Hartmann, Anterior resection
Stoma Complications
- Early
- Late
Early
- Dehydration/High Output (>1500m/L 24 Hours)
- Ischemia
- Bowel Obstruction
- Mucocutaneous Separation
Late
- Retraction/Prolapse => Stenosis
- Parastomal Herniation (50% overall. More common in obese patients and those with COPD)
- Peristomal skin ulceration/inflammation
- Bowel Obstruction
- Bleeding
- Psychosexual Issues
Indications for surgical intervention on stoma?
Strangulation, obstruction and ischemia
Indications for stoma formation?
Resection of diseased portion of bowel:
- Hartmann’s procedure
- abdominoperineal resection (APR)
- panproctocolectomy
Feeding: Gastrostomy/Jejunostomy
Diversion: Protect distant bowel (anastomosis/fistula/abscess)
Decompression: To relieve distal obstruction (loop colostomy)
Lavage: Temporary stoma for on-table lavage prior to bowel resection
How to determine if an end colostomy is temporary or permanent?
Ask the patient if they still have a back passage or not
-
Yes: Temporary end colostomy; e.g. Hartmann’s procedure or Anterior
Resection - No: Permanent end colostomy; APR for low rectal tumor
Indication for Right hemicolectomy?
Caecal & ascending colon tumours
Indicaiton for Extended right hemicolectomy?
Extended right hemicolectomy
Indication for Left hemicolectomy
Descending colon tumours
Indications for Sigmoid Colectomy
Sigmoid colon tumour
Diverticular disease
Indications for Anterior resection
Low sigmoid or high rectal tumour
Indications for Abdominoperineal resection (APR)
Low rectal tumour
Indications for Panproctocolectomy
Ulcerative colitis, FAP
Define Hartmann’s Procedure
Removal of the sigmoid colon with closure of the rectal stump and formation of a potentially reversible end colostomy
Define Panproctocolectomy
Removal of the entire colon, rectum and anus, forming a permanent end colostomy
Define Abdominoperineal resection:?
Removal of the lower rectum and anus with
formation of a permanent end colostomy
