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Nursing Considerations in Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Margaret Birdsong, Michelle Felix
Ostomy: A surgically formed opening from the inside of an organ to the outside. Stoma: The part of the ostomy that is attached to the skin. It is (usually) constructed from the end of the bowel that has been surgically brought up through the skin and attached to the underlying fascia.Ileostomy: A stoma that is created from the small intestine. The output is liquid and may appear to be undigested.Colostomy: Created from the colon and diverted through the abdomen. The output may initially be meconium, becoming yellow and curdy.Jejunostomy: Created from a more proximal section of the small intestine. The output may be quite watery and corrosive to the neighboring skin.Mucous fistula: The other end of the nonfunctioning bowel, which is delivered through the abdomen—the distal bowel end.High-output stoma: Any stoma that produces greater than or equal to 20 mL/kg of effluent. Management of high-output stomas requires careful replacement of gastrointestinal losses and attention to electrolytes in order to prevent complications.
Small Bowel Crohn’s Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Barry Salky, Naif Alenazi, André D’Hoore, Michael R.B. Keighley
The method of ileostomy construction will depend on whether this is an end or loop ileostomy. In end ileostomy, the open terminal ileum is everted and sutured to the peristomal skin (see Figure 61.13). In loop ileostomy, the distal loop is opened, the apex if the limb is grasped with an Allis tissue forceps, the proximal end is inverted and mucocutaneous maturation is achieved with sutures (see Figure 61.14).
The Small Intestine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
There may be an ‘ileostomy flux’ while the ileum adapts to the loss of the colon. While ileostomy output can amount to 4 or 5 litres per day, losses of 1-2 litres are more common. A consistent ileostomy output in excess of 1.5 litres is usually associated with dehydration and sodium depletion in the absence of intravenous therapy. The stools thicken in a few weeks and are semisolid in a few months. The help, skill and advice of the stoma care nurse specialist are essential. Modern appliances have transformed stoma care, and skin problems are unusual (Figure69.14). Complications of an ileostomy include prolapse, retraction, stenosis, bleeding, fistula and parastomal hernia.
Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy
Published in Acta Chirurgica Belgica, 2022
Pablo Calvo Espino, Arsenio Sánchez Movilla, Isabel Alonso Sebastian, Jesús García Schiever, David Varillas Delgado, Víctor Sánchez Turrión, Javier López Monclús
The ileostomy closures were performed under general anaesthesia by a colorectal surgeon or by a supervised general surgery resident. The prophylactic antibiotic was administered in every case. The surgery was initiated with a mucocutaneous disinsertion and a circular incision, as close as possible to the edge of the ileostomy. Patients with a terminal ileostomy also required a median laparotomy. After performing adhesiolysis, stoma resection and manual or mechanical latero-lateral anastomosis followed. Fascia closure was performed with a ‘large bites’ technique and a suture to wound length ratio of 4/1, using slow absorbing 0 or 1 monofilament in 96.5% of patients, and a fast-absorbing multifilament in 7/202 patients (3.5%). Skin closure was performed using a purse-string suture, leaving no drainage.
Loop-ileostomy reversal in a 23-h stay setting is safe with high patient satisfaction
Published in Scandinavian Journal of Gastroenterology, 2021
Kevin Afshari, Maziar Nikberg, Kenneth Smedh, Abbas Chabok
All operations were performed by either a general surgeon during subspecializing or a resident supervised by a consultant colorectal surgeon. All patients were operated under general anesthesia, with total intravenous analgesia. Loop-ileostomy closure was performed in a standardized manner using a circumstomal technique. The edges of both limbs were resected and the stoma was closed either with running sutures with absorbable monofilament (Biosyn®) 4–0 suture using a serosubmucosal technique or side-to-side anastomoses fashioned with a linear staple. The aponeurosis was closed using polydioxanone suture 0–0 (PDS). Before closing the skin, the wound was infiltrated with a local anesthetic (0.5% Marcain®). The skin was closed with non-absorbable monofilament (Ethilon®) 4–0 sutures a purse string suture. Patients were thereafter admitted to the postanesthesia care unit (PACU) for observation.
Laparoscopy-Assisted Versus Open Surgery in Treating Intestinal Atresia: Single Center Experience
Published in Journal of Investigative Surgery, 2021
Mario Lima, Neil Di Salvo, Chiara Cordola, Simone D’Antonio, Michele Libri, Michela Maffi, Tommaso Gargano, Giovanni Ruggeri, Vincenzo Davide Catania
Pneumoperitoneum is created with 6–7 mmHg of pressure and 0.5–1 L/min of flow of Carbon dioxide. The abdominal cavity is carefully explored until the identification of the steno-atresic segment is identified. The pathological tract is then exteriorized through the umbilical incision. Considering the elasticity of the neonatal umbilical ring, the skin and subcutaneous tissue around the umbilical trocar site can be easily expanded (without widening the incision) to bring out both ileal atretic ends through the umbilical incision (Figure 2). The whole intestine is then exteriorized and irrigated with water. The entire distal small bowel is then investigated to exclude any other malformation in the distal bowel. This procedure can also be performed laparoscopically to avoid bowel loops manipulation. The proximal atresic/stenotic bowel end should then be resected or tapered, as required, leaving the bowel opening the same size as the distal bowel to facilitate an end-to-end primary anastomosis (Figure 3). The laparoscope is reintroduced to confirm no kinking or torsion of the anastomosis and no drains are left in place. A temporary ileostomy is performed in instances of perforation, or if there is a question of bowel viability.