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    DR - Arvind Pratap PPT Ileostomy

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    DR - Arvind Pratap PPT Ileostomy

    Uploaded by

    kinshipsinkip
    16 views39 pages

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    Dr.arvind Pratap Ppt Ileostomy

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    16 views39 pages

    DR - Arvind Pratap PPT Ileostomy

    Uploaded by

    kinshipsinkip

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    Ileostomy

    Dr. Arvind Pratap


    Department of general surgery
    IMS BHU
    ILEOSTOMY

    Ileostomy is an operation that creates an opening from

    the ileum , through the abdomen


    SMALL BOWEL

    • 20 feet . (6 meters.)
    • Duodenum; 20-30 cm in length
    • Jejunum: 8 feet ( 2.5 meters)
    • Ileum: 12 feet (3.5 meters)

    • The exact length can vary based on factors such as age, sex,
    and individual physiology.
    • The small bowel (small intestine) attachements

    • Mesentery: attaches small intestine to the posterior


    abdominal wall.
    • Ligament of Treitz: - suspensory muscle of the
    duodenum
    -marks transition from the duodenum to the
    jejunum.
    -support the duodenum.
    WHAT IS AN OSTOMY

    • An opening
    • In the small intestine or large intestine
    • Created as an outlet through the anterior abdominal
    wall
    • In order to pass fecal matter into a bag
    • STOMA = part of intestine we use to create this outlet
    TYPES

    Classification is normally based on

    • Duration

    • Anatomic part of bowel used

    • Loop, End, Double barrel ileostomy


    ETIOLOGY / INDICATION

    • Inflammatory Bowel Disease (IBD)


    • Perforation peritonitis
    • Obstruction
    • Birth Defects: (Hirschsprung's disease)
    • Protect a distal anastomosis
    • Ruptured diverticulum
    • Ischemia
    • Necrotizing enterocolitis
    • Intestinal atresia, stenosis, and webs
    • Trauma
    STOMA SITE SELECTION

    • Positions
    • Type of stoma anticipated
    • The rectus muscle sheath
    • Adequate surface area
    • Easily seen
    • Smooth skin surface
    • Miscellaneous criteria
    IDEAL STOMA CHARACTERISTICS

    • Red
    • Round
    • Raised about 1” protrusion)
    • Lumen at centre of stoma
    • Smooth skin surface
    SITE TO AVOID

    • Scar / Wrinkles
    • Skin folds / Creaks
    • Bony prominence
    • Suture line
    • Umbilicus
    • Belt/ waist line
    • Hernia
    • Mobile abdominal tissue
    • Radiation site
    LOOP ILEOSTOMY
    •Incision: Makes an incision in the lower right quadrant of
    the abdomen.
    •Exposing the Bowel: The abdominal cavity is opened,
    and the small intestine is carefully exposed and assessed for
    the most suitable section to create the stoma.

    •Loop Formation: A loop of the small intestine is chosen,


    and a section of it is brought out through the abdominal wall to
    create the stoma.

    •Fixation: The loop of intestine is secured to the abdominal


    wall with sutures to prevent it from slipping back into the
    abdomen, and sterile dressings are applied to the wound.
    Cont..
    •Creating the Stoma: Opening in the abdominal
    wall for the stoma, which is typically round (1 to 2
    inches in diameter).

    •Stoma Care: The edges of the stoma are


    trimmed and prepared to ensure they are smooth
    and flush against the abdominal wall.

    •Protective Barrier: A protective barrier, such as a


    stoma powder or paste, may be applied around the
    stoma to protect the skin and help adhere the
    pouching system.
    Cont..

    •Pouching System: A pouching system (ostomy


    bag) is fitted over the stoma to collect fecal matter.
    This system must be changed regularly to maintain
    skin integrity and prevent leaks.

    •Closing the Incision: The abdominal incision is


    closed with sutures or staples, and sterile
    dressings are applied to the wound.
    END ILEOSTOMY

    • Make an appropriate incision in the abdominal wall


    2.5cm disc incision to skin
    • Cruciate to other layers of ant abdomen
    • Insert a crushing clamp through it and draw out the
    proximal end of gut
    Cont..

    • Put in a few catgut sutures between the seromuscular


    coat bowel and the peritoneum of the abdominal wall
    with 1.5 cm of healthy gut protruding beyond the skin
    • Close abdominal wound
    • Cut off the crushing clamp to open the ileostomy
    • Suture mucosa to skin all round with interrupted 2/0
    or 3/0 monofilament.
    POSTOP CARE

    • Vital signs monitoring


    • Pain medication given as necessary
    • Support of operative site during deep breathing and
    coughing
    • Fluid intake and output measurement
    • Intravenous antibiotics
    • operative site observed for color and amount of
    wound drainage
    • NG tube
    COMPLICATIONS OF STOMA

    Early
    1. Ischemia
    2. Bleeding
    3. Retraction
    4. Skin excoriation
    Late

    1. Prolapse
    2. Peristromal hernia
    3. Recurrent disease
    4. Bowel obstruction
    ISCHEMIA

    • Due to impaired blood flow

    • Poor blood supply when stoma is formed

    • Too tight stoma bag

    • Too tight dresses over stoma


    MANAGEMENT

    • Close observation during post op period

    • A clear plastic appliance should be fitted

    • Avoid tight clothing

    • Inform your surgeon if you notice any colour change


    BLEEDING

    • Over enthusuastic cleaning


    • When using template for measurement
    • Bleeding from lumen is more serious
    • Portal HPT in cirrhosis
    MANAGEMENT

    • Do not rub your stoma

    • Be careful when applying the bag

    • Compress with guaze

    • Usually resolve without interventions


    RETRACTION

    • Recession of the stoma


    • Away from the skin surface
    • Due to excess tension of the stoma
    • Insufficiant fixation
    • Post op weight gain
    MANAGEMENT

    • Use and appliance with rigid flange

    • Apply stoma adhesive paste before fixing appliance


    • Herniation vs prolapse Herniation Stoma
    prolapse
    EXCORIATION OF SKIN

    • Make sure the wafer and the pouch are well fixed
    • Control excessive mucus discharge
    • Be cautious of the size of the stoma and the wafer
    • Use luke warm water and mild soap to clean the
    peristomal skin
    • Never use alcohol agents, savlon, creams, powder or
    chemical agents to clean
    • Never use artificial drying methods. Ex: hair driers
    MANAGEMENT

    • Educate the patient about appliance change


    • Consider a 2 piece appliance to allow healing
    • Use stoma adhesive powder or paste
    • Do not use antiseptics for cleaning peristomal skin
    • Change the base plate as soon as it leaks
    • A methyl cellulose skin wafer is helpful

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