Colostomy

WHAT IS STOMA It is an artificial opening from the intestine on the abdominal wall usually created by a surgeon

colostomy

Colostomy refers to a surgical procedure where a portion of the large intestine is brought through the abdominal wall to carry stool out of the body.

It may be permanent or temporary.

Indication

A colostomy is created as a means to treat various disorders of the large intestine, including cancer, obstruction, inflammatory bowel disease, ischemia (compromised blood supply), or traumatic injury.

In a baby or child it may be due to an imperforate anus which is the absence of an anal opening.

It also may be due to Hirschsprung ’s Disease, or it may be due to other malformations that are present at birth

complication

Potential complications of colostomy surgery include 1-excessive bleeding 2-surgical wound infection 3-thrombophlebitis (inflammation and

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blood clot to veins in the legs

Stomal complications to be monitored include Death (necrosis) of stomal tissue. Caused by inadequate blood supply, this complication is usually visible 12-24 hours after the operation and may require additional surgery • •

2 Retraction (stoma is flush with the • ) abdomen surface or has moved below it

3 Prolapse (stoma increases length above the surface of the abdomen 3 Stenosis (narrowing at the opening of the stoma).

Often associated with infection around the stoma or scarring

There are four main types of colostomies . named after the portion of the bowel where the colostomy is located.

An Ascending

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colostomy is located within the ascending colon.

A Transverse

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colostomy is located within the transverse colon.

A Descending Colostomy

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is located within the descending colon.

A Sigmoid Colostomy is located within the sigmoid colon.

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Preparation 1-The patient will be required to sign a consent form after the procedure is explained thoroughly.

2-Blood and urine studies, 3-x rays and an electrocardiograph (EKG), may be ordered as the doctor deems necessary.

4-In order to empty and cleanse the bowel, the patient may be placed on a for several days prior to surgery. A liquid diet may be ordered for at least the day before surgery, with nothing by mouth after midnight.

5-A series of enemas may be ordered to empty the bowel of stool.

6-Oral anti-infective (neomycin, erythromycin, may be ordered to decrease bacteria in the intestine and help prevent post-operative infection. 7-A nasogastric tube is inserted from the nose to the stomach on the day of surgery or during surgery to remove gastric secretions and prevent nausea and vomiting.

8-A urinary catheter (a thin plastic tube) may also be inserted to keep the bladder empty during surgery, giving more space in the surgical field and .

decreasing chances of accidental injury

Aftercare

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Monitoring of blood pressure, pulse, respirations, and temperature.

-The patient is instructed how to support the operative site during deep breathing and coughing, and given pain medication as necessary.

-Fluid intake and output is measured, and the operative site is observed for color and amount of wound drainage.

-The nasogastric tube will remain in place, attached to low intermittent suction until bowel activity resumes.

-For the first 24-48 hours after surgery, the colostomy will drain bloody mucus. -Fluids and electrolytes are infused intravenously until the patient's diet is can gradually be resumed, beginning with liquids. -Usually within 72 hours, passage of gas and stool through the stoma begins. Initially the stool is liquid, gradually thickening as the patient begins to take solid foods.

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-The patient is usually out of bed in 8-24 hours after surgery and discharged in 2-4 days -A colostomy pouch will generally have been placed on the patient's abdomen, around the stoma during surgery.

-During the hospital stay, the patient and his or her caregivers will be educated on how to care for the colostomy. Regular assessment to the skin surrounding the stoma is important.

Pouching systems are classified as

TWO-PEECE; STANDARD CLOSED-END POUCH WITH FILTER ONE-PIECE DRIENAINABLE POUCH WITH FILTER

Requirements

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A new appliance.

warm water.

soft tissues or gauze wipes.

disposable bag.

Changing the appliance:

wash your hands.

remove the old appliance carefully from the top down and avoid dragging the skin.

wash the stoma and surrounding skin, gently removing all waste.

place prepared appliance over stoma.

spend a few minutes moulding flang to skin.

do not forget to attach the clip (drainable bag) place the empty old appliance in the disposal bag wash your hands.

Types of foods can I eat after a colostomy People with colostomies can eat a regular diet.

Choose healthy foods from all the food groups To avoid constipation, eat foods such as oatmeal, whole-grain breads and cereals, fruits and vegetables You may want to avoid foods that cause gas and odor. Some foods that may cause gas and odor are vegetables such as broccoli, cabbage, and cauliflower.

Other foods include beans, eggs, and fish. You can also reduce gas by eatin slowly and not using straws to drink liquids.

Foods that may help to control odor and gas in some people are fresh parsley , yogurt and buttermilk