Stomas And Urostomas Flashcards
Main reason for colostomy without bowel obstruction?
Abdominoperineal resection (with imperforate anus) A low rectal lesion with permanent colostomy as too low for anastomosis
Examination of a stoma
Where? Colostomy usually left iliac fossa; ileostomy usually right iliac fossa
Is there a spout (ileostomy) or is it flush (colostomy)?
Is it producing solid faeces (colostomy), liquid faeces (ileostomy), urine (ileal conduit) or just mucus (mucous fistula)?
Is there one opening (most stomas) or two (loop stomas)
“Site, spout, what comes out”
Why is rectal surgery so difficult?
Hard to mobilise
Easy to damage the pre sacral plexus -> autonomic dysfunction! decreased sexual function
Hartmann’s original procedure
Mucus fistula of rectum, a double barrelled stoma with two separate tubes
Modified Hartmann’s Procedure
Primary resection with delayed anastomosis
Excise lesion,create colostomy and leave over-sewn rectal stump
Mainly used for carcinoma with acute obstruction
Occasionally for diverticular disease with perforation or diverticular abscess
Option of restorative anastomosis at a later stage
Ddx for calcified mass on abdominal Xray
Calcified faeces
Bladder stone
Prostate
Fibroid
Fistula definition
Abnormal connection between two epithelial membranes
Loop ileostomy
Increasingly used in colorectal surgery to protect distal anastomosis from rupturing at suture sites
Eg used to protect a sigmoid colectomy or an anterior resection
Typically reserved after 6 weeks
Has largely replaced loop transverse colostomy as easier to create and reverse
Complications of stomas
Fluid loss (esp ileostomy) Odour Ulceration of skin (esp ileostomy) Leakage Stenosis Prolapse Retraction Herniation (parasomal hernia) Ischemia Terminal ileum loss - failure to absorb bile salts or Vit B12 Sexual and psychological problems
Ileal Conduit (urostomy)
Usually due to invasive bladder ca
Ureters are too fine to be brought directly onto body surface and urine is toxic to skin
Length of ileum (the conduit) is isolated, but left on its vascular pedicle
Anastomosis of the two remaining ends of ileum from which the conduit has been detached
The ureters are implanted into the ileal reservoir, after removal of the bladder
Distal end of conduit brought out as an ileostomy (with typical spout, inverted end)
Catheter left in situ post op to reduce incidence of stricture
Hyperchloraemic acidosis with urostomy
Can sometimes happen as the bowel mucosa has an ion pump. The ileum can reabsorb urinary chloride and loses bicarbonate in exchange. This leads to metabolic acidosis.
More common when ureters were transplanted into the sigmoid colon as a false bladder and urine was in contact with the bowel for some time
Definition of stoma
Opening of any part of the gut out to the surface
