Known complication of stoma (e.g., Colostomy stoma)
Correct Answer: All of the above
Description: Ans. d (All of the above) (Ref. Bailey and Love 24th ed., 57.10)Complications of colostomies: The following complications are more common after poor technique:# Prolapse;# Retraction;# Necrosis of the distal end;# Stenosis of the orifice;# Colostomy hernia;# Bleeding (from granulomas around margin of colostomy);# Colostomy 'diarrhoea': this is usually an infective enteritis and will respond to oral metronidazole 200 mg TID.STOMASColostomy# A colostomy is an artificial opening made in the large bowel to divert faeces and flatus to the exterior, where it can be collected in an external appliance. Depending on the purpose for which the diversion has been necessary a colostomy may be temporary or permanent.# Temporary colostomy- This is most commonly established to defunction an anastomosis after an anterior resection, to prevent faecal peritonitis developing following traumatic injury to the rectum or colon, and to facilitate the operative treatment of a high fistula in ano. It is now less commonly used for patients with distal obstruction of the sigmoid colon as a result of carcinoma or diverticular disease.# Double-barrelled colostomy- This colostomy was designed so that it could be closed by crushing the intervening 'spur' using an enterotome or a stapling device. It is rarely used now but occasionally the colon is divided so that both ends can be brought separately to the surface ensuring that the distal segment is completely defunctioned.# Permanent colostomy- This is usually formed after excision of the rectum for a carcinoma by the abdominoperineal technique (APR).- It is formed by bringing the distal end (end colostomy) of the divided colon to the surface in the left iliac fossa, where it is sutured in place joining the colonic margin to the surrounding skin.- The point at which the colon is brought to the surface must be carefully selected to allow a colostomy bag to be applied without impinging on the bony prominence of the anterosuperior iliac spine. The best site is usually through the lateral edge of the rectus sheath, 6 cm above and medial to the bony prominence.Loop ileostomy# An ileostomy is used by some surgeons as an alternative to colostomy, particularly for defunctioning a low rectal anastomosis. The creation of a loop ileostomy from a knuckle of terminal ileum has already been described. The advantages of a loop ileostomy over a loop colostomy are the ease with which the bowel can be brought to the surface and the absence of odour. Care is needed, when the ileostomy is closed, that suture line obstruction does not occur.Caecostomy# This is rarely used now. In desperately ill patients with advanced obstruction, a caecostomy may be useful. Caecostomy is only a short-term measure to allow a few days for the condition of the patient to improve. Reoperation should normally follow fairly soon thereafter and a proper surgical procedure carried out.
Category:
Surgery
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