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Colostomy

                               
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Colostomy

Definition

A colostomy is really a surgical treatment which brings some from the large intestine with the abdominal wall to transport feces from the body.

Purpose

A colostomy is really a way to treat numerous disorders from the large intestine, which includes cancer, obstruction, inflammatory bowel disease, ruptured diverticulum, ischemia or traumatic injury. Temporary colostomies are designed to divert stool from injured or diseased portions from the large intestine, permitting rest and healing. Permanent colostomies are carried out once the distal bowel should be removed or perhaps is blocked and inoperable. Although colorectal cancer is easily the most common indication for any permanent colostomy, no more than 10%-15% of patients with this particular diagnosis need a colostomy.

Who performs the process and where could it be conducted?

General surgeons and colon and rectal doctors perform colostomies as inpatient surgeries, under general anesthesia.

Demographics

Estimates of ostomy surgeries vary from 42,000 to 65,000 every year; about 50 % are temporary. Emergency surgeries for bowel blockage and/or perforation comprise 10%-15% of colorectal surgeries; some of those lead to colostomy.

Description

Surgery can lead to among three kinds of colostomies:

• Loop colostomy. This surgery brings a loop of bowel with an incision within the abdominal wall. The loop is locked in place away from abdomen with a plastic rod slipped beneath it. An incision is created within the bowel to permit the passage of stool with the loop colostomy. The supporting rod is taken away around 7 to Ten days after surgery, when recovery has occurred which will avoid the loop of bowel from retracting to the abdomen. A loop colostomy is frequently performed for advance of a brief stoma to divert stool from a place of intestine that's been blocked or ruptured.
• End colostomy. The functioning end from the intestine is the fact that portions of bowel that continues to be attached to the upper gastrointestinal tract, is presented onto the top of abdomen, forming the stoma by cuffing the intestine back on itself and suturing the finish towards the skin. The top of stoma is really the liner from the intestine, normally appearing moist and pink. The distal part of bowel might be removed, or sutured closed and left within the abdomen. A finish colostomy is generally a permanent ostomy, caused by trauma, cancer, or another pathological condition.
• Double-barrel colostomy. This requires the advance of two separate stomas about the abdominal wall. The proximal stoma may be the functional end that's attached to the upper gastrointestinal tract and can drain stool; the distal stoma, attached to the rectum as well as known as a mucous fistula, drains small quantities of mucus material. This really is usually a brief colostomy carried out to relax a place of bowel, and also to be later closed.
  

Questions a patient should ask a doctor:

• What should a patient have to complete to organize for surgery?
• What types of preoperative tests is going to be needed?
• What will a patient’s recovery time be and what limitations going to have?
• What drugs will be presented for pain following the surgery?
• Is there an ostomy support group in the hospital which a patient can attend?
• Is there an enterostomal therapist patient will speak with prior to the surgery?
  

Diagnosis/Preparation

Numerous diseases and injuries may need a colostomy. One of the diseases is inflammatory bowel disease and colorectal cancer. Identifying whether this surgery is essential is really a decision problems makes with different quantity of factors, such as patient history, quantity of pain, and also the outcomes of tests for example colonoscopy minimizing G.I. (gastrointestinal) series. Because of lifestyle impact from the surgery, a decision is made after careful consultation with the patient. However, an instantaneous decision might be produced in emergency circumstances involving injuries or puncture wounds within the abdomen or intestinal perforations associated with diverticular disease, ulcers, or life-threatening cancer.

Just like any surgical treatment, the individual is going to be necessary to sign a consent form following the procedure is described thoroughly. Blood and urine studies, together with various x-rays as well as an electrocardiograph (EKG), might be ordered since the doctor deems necessary. If at all possible, the individual should visit an enterostomal therapist, who'll mark a suitable place on the abdomen for that stoma and gives preoperative education on ostomy management.

To be able to empty and cleanse the bowel, the individual might be positioned on a low-residue diet for a few days just before surgery. A liquid diet might be ordered not less than previous day of surgery, with nothing orally after midnight. A number of enemas and/or oral preparations might be ordered to take out the bowel of stool. Oral anti-infectives (neomycin, erythromycin, or kanamycin sulfate) might be ordered to diminish bacteria within the intestine and assist in preventing postoperative infection. A nasogastric tube is placed in the nose towards the stomach at the time of surgical procedures or during surgery to get rid of gastric secretions and stop nausea and vomiting. A urinary catheter can also be inserted to maintain the bladder empty in the course of surgery, giving more space within the surgical field and lowering likelihood of accidental injury.

Risks

Potential problems of colostomy surgery include:

• pneumonia
• excessive bleeding
• pulmonary embolism
• surgical wound infection
• thrombophlebitis
  

Psychological problems may derive from colostomy surgery due to the concern with the perceived social stigma mounted on wearing a colostomy bag. Patients can also be depressed and also have feelings of low self-worth due to the alternation in their lifestyle and the look of them. Some patients may go through ugly and sexually unattractive and could worry that their spouse or mate won't locate them appealing. Counseling and education concerning surgery and also the inherent change in lifestyle in many cases are necessary.

Normal results

Complete healing is anticipated without problems. The time necessary for recovery in the surgery can vary with respect to the patient's all around health just before surgery and also the patient's willingness to take part in stoma care. The colostomy patient without other medical problems will be able to resume all day to day activities once recovered in the surgery. Modifications in diet and daily personal care will have to be made.

Morbidity and mortality rates

Problems after colostomy surgery may appear. A doctor ought to be made conscious of the following problems after surgery:

• headache, muscle aches, dizziness, or fever
• increased abdominal swelling or pain, constipation, nausea / vomiting, or black, tarry stools
• increased pain, swelling, redness, drainage, or bleeding within the surgical area
  

Stomal problems also occur. They include:

• Retraction. Brought on by insufficient stomal length, this problem might be managed by utilization of special pouching supplies. Elective revision from the stoma can also be a choice.
• Death of stomal tissue. Brought on by inadequate circulation, this complication is generally visible 12-24 hours following the operation and could need additional surgery.
• Prolapse: Usually this results from a very large opening within the abdominal wall or insufficient fixation from the bowel towards the abdominal wall. Surgical correction is needed when circulation is compromised.
• Stenosis: Often this really is related to infection round the stoma or scarring. Mild stenosis can be taken off under local anesthesia; severe stenosis may need surgery for reshaping the stoma.
• Parastomal hernia: This happens because of keeping the stoma in which the abdominal wall is weak or a very large opening within the abdominal wall is made. Using an ostomy support belt and special pouching supplies might be adequate. If serious, the defect within the abdominal wall ought to be repaired and also the stoma gone to live in another location.
  

Mortality rates for colostomy patients vary based on the patient's overall health upon admittance towards the hospital. Even among greater risk patients, mortality is all about 16%. This minute rates are reduced once the colostomy is conducted with a board-certified colon and rectal surgeon.

Aftercare

Postoperative look after the patient with a brand new colostomy, just like anyone who has had any major surgery, requires monitoring of blood pressure level, pulse, respirations, and temperature. Breathing is commonly shallow due to the effect of anesthesia and also the patient's desire not to breathe deeply and experience pain that's brought on by the abdominal incision. The individual is instructed how he/she can offer the operative site during breathing and coughing, and given pain medicine as necessary. Fluid intake and output is measured, and also the operative site is noticed for color and quantity of wound drainage. The nasogastric tube will stay in position, mounted on low, intermittent suction until bowel activity resumes. For that first 24-48 hours after surgery, the colostomy will drain bloody mucus. Fluids and electrolytes are infused intravenously before patient's diet can progressively be resumed, patients start with liquids. Generally within 72 hours, passage of gas and stool with the stoma begins. In the beginning, the stool is liquid, slowly thickening since the patient starts to take food. The individual is generally up out of bed in eight to Twenty four hours after surgery and discharged by 50 percent to four days.

A colostomy pouch will normally happen to be positioned on the patient's abdomen round the stoma during surgery. Throughout the hospital stay, the individual and or her caregivers is going to be educated regarding how to look after the colostomy. Resolution of appropriate pouching supplies along with a schedule of how frequently to alter the pouch ought to be established. Regular examination and meticulous proper care of patient’s skin surrounding the stoma is essential to keep a sufficient surface which to add the pouch. Some patients with colostomies can routinely irrigate the stoma, leading to unsafe effects of bowel function; instead of having to wear a pouch, these patients may require a dressing or cap over their stoma. Often, an enterostomal therapist will go to the patient within the hospital or in patient’s own home after discharge to assist the individual with stoma care.
Dietary counseling is going to be essential for the individual to keep normal bowel function and also to avoid constipation, impaction, along with other discomforts.

Alternatives

Whenever a colostomy is considered necessary, you will find usually no other options to a surgery, though there might be alternatives within the kind of surgery required and adjuvant therapies associated with the condition. For instance, laparoscopic surgery has been combined with many diseases from the digestive tract, including initial cancers. With this surgery, the colon and rectal doctor inserts a laparoscope via a small incision within the abdomen. Other small incisions are created for that surgeon to insert laparoscopic devices to make use of in making the colostomy. This surgery often leads to a shorter remain in a healthcare facility, less postoperative pain, a faster go back to normal activities, and much less scarring. It's not suitable for patients who may have had extensive prior abdominal surgery, large tumors, previous cancer, or serious heart disease.

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