Description
This academic tutorial material provides a detailed overview of Colostomy, authored by Dr Mukonka for 7th Year students, with a focus on paediatric surgery. The document covers the history of the procedure, definitions of stomas, and their various purposes including feeding, decompression, and faecal diversion. It outlines the different types of stomas, specifically detailing colostomies, their congenital and acquired indications such as anorectal malformations, Hirschsprung's disease, intestinal obstruction, trauma, and tumours. The material classifies colostomies based on temporal, anatomical, and constructional criteria, explaining divided and loop types. It comprehensively lists both early and late complications, including haemorrhage, skin excoriation, prolapse, stenosis, and parastomal hernia. This resource is essential for tertiary-level medical and surgical students preparing for examinations, offering authoritative content on the principles, indications, and management of colostomies. Review this guide to support your revision and clinical understanding.
What's inside
COLOSTOMY 7TH Year Tutorial Dr Mukonka ( Paeds Surgery Senior Registrar) Layout History Definitions Types of Stomas Colostomy Indications for colostomy Types of colostomies Complications HISTORY Alexis Littre (1658-1726): Anatomist. Pillorie of Rouen :1776 performed the first colostomy in ca rectum pt. Debois: 1783 ,first paediatric colostomy Definitions Stoma: from the Greek word ”stomoun” to provide with an opening or mouth . Deliberate creation of an opening that communicates between the GIT and the exterior. Purpose of Stomas Feeding, Drug administration, Bowel decompression, Protecting distal anastomosis or other gut lesions, Controlling faecal effluent in some cases of incontinence, A combination of these indications. Types Of Stomas Gastrostomy Enterostomy -Duodonostomy, Jejunostomy, ileostomy Caecostomy Appendicostomy Sigmoidostomy Colostomy Types of Stomas Gastrostomy creation of an opening between the stomach and the skin. feeding drug administration Proximal decompression of the GIT. Oesophageal obstruction due to corrosive oesophageal stricture severe maxillofacial trauma, Achalasia of the cardia oesophageal carcinoma (in adults). Types of Stomas Jejunostomy/Ileostomy Commonly used for feeding bowel decompression,or diversion of distal disease. Specific indications include • Bypass of gastric outlet obstruction; • Protection of distal anastomosis. Obstructive distal bowel lesions. • To rest and/or decompress distal bowel in cases of perforation colostomies Colostomy Defn: stoma of the colon with the aim of diverting faeces and flatus. Iatrogenic Colocutaneous fistula Indications For Colostomy CONGENITAL OR ACQUIRED Congenital indications :common High anorectal anomalies –ARM (imperforate anus) Rectovesical/rectovaginal fistula, cloacal exstrophy, and severe spina bifida with incontinence. Hirschsprung’s disease. Colonic Atresia For faecal diversion prior to resection of large congenital intrapelvic masses. Indications For Colostomy ACQUIRED INDICATIONS Intestinal obstruction e.g. sigmoid volvulus Gangrenous bowel due to strangulation Ischaemic bowel disease Penetrating trauma to the bowel Rectovaginal fistula prior to repair Tumors :Anal ca, Rectal ca Protecting an anastomosis of gut resection Stenosis or stricture i. Early complications - RXN to anastesis - Hemorrhage - Stomal diarrhea- water - Electrolyte imbalance - Skin excoriation - Ischemic gangrene- necrosis ii. Late Indication for colostomy Decompression Diversion - Urinary Protect distal bowel anastomosis Classification of Colostomies Base on temporal, anatomical, or constructional criteria. Temporal Classification Temporal classification is based on the anticipated duration of the stoma and is either temporary or permanent. Anatomical Classification Anatomical classification is based on the anatomical portion of the colon in which the stoma is sited. Sigmoid colostomy, Transverse colostomy, right-transverse, mid-transverse, left-transverse colostomy; Caecostomy, Constructional Classification Constructional classification is based on how the stoma is constructed, Two major types: loop colostomy and divided colostomy Divided colostomy Divided colostomy the bowel is completely divided and the bowel Continuity interrupted. Intestinal content does not enter the distal bowel, Divided stomas are also called defunctioning stomas. The most common variations are the double-barrel, Devine, and end stomas’, Double-barrel stoma Both the proximal and distal limbs may or may not be plicated together but are brought out side-by-side through the same wound like a doublebarrel gun Devine stoma In a Devine stoma, both proximal and distal limbs are brought out separately, sometimes through different incisions, and are separated by a skin bridge. End stoma Here the proximal limb is brought out to evacuate faeces and flatus, The distal limb is closed or oversewn and returned to the peritoneal cavity. Loop colostomy Complications of Colostomies Can be Early or Late complications Early complications Anaesthetic related Hemorrhage Stomal diarrhea Electrolyte imbalance Skin excoriation Ischemic gangrene- necrosis Late Complications Prolapsed Stenosis Retraction---- peritonitis at site Fistula Parastomal hernia Incisional hernia later Nutritional disorders Late complications …. Residual disease Parastoma fistula Psychosocial problems Impotence in men Loss of libido Stomal Retraction Stomal Prolapse Parastomal Hernia
An extract of the text. Open the file below to read the full document.