Nursing Considerations in Necrotizing Enterocolitis
David J. Hackam in Necrotizing Enterocolitis, 2021
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.
Assessing and managing pain
Nicola Neale, Joanne Sale in Developing Practical Nursing Skills, 2022
To illustrate pain tolerance, think of two individuals. One has had a formation of a colostomy as part of a curative procedure for bowel cancer. The next person has had a colostomy formed following trauma. The person who has had a curative procedure is feeling positive about their future, which has now been given back to them; the stoma is a small price to pay for their life, and they were prepared for it during clinic appointments. The person who has undergone trauma has had their life changed very quickly; they are likely to be experiencing a great deal emotionally, and are trying to process how their life will change; they would not have undergone a pre-operative work up. In these two very similar procedures, these individuals are likely to have very different levels of pain.
Stoma and Its Complications
Haribhakti Sanjiv in Laparoscopic Colorectal Surgery, 2020
The word stoma (or ostomy) is derived from Greek and means ‘mouth’. It is created by a surgical procedure consisting of forming an aperture in the intestine and placing it on the anterior abdominal wall. This aperture allows the patient to eliminate feces and urine out of the body, and to administer nutritional and therapeutic substances. The stoma can be either intestinal or urinary. Intestinal stoma are either an ileostomy or colostomy. There are both advantages and disadvantages of ileostomies and colostomies, and the choice of stoma is based on the nature of the disease and the morbidities associated with a particular type of stoma. Several predictors of high-risk stomas are studied here, as well as a few techniques – such as identifying compromised vascularity and transanal rectal tube drainage – are described for reducing anastomotic leak rates and thus avoiding the creation of diversion stoma. It is important to understand the appropriate time for reversal of stoma. It depends on disease and treatment factors, and reversal of stoma cannot be attempted too early nor can it be delayed too late.
A giant parastomal hernia in a high risk patient: preparation to make surgery worthwhile
Published in Acta Chirurgica Belgica, 2023
Seda Gunes, Ali Bohlok, Antoine El Asmar, Thibaut Engels, Marie Magdelaine Lefort, Eleonora Farinella, Issam El Nakadi
The first-step surgery started by closing the colostomy. Then, a circular skin incision was made 3 cm above the edge of the hernia’s neck to keep enough skin for the subsequent closure. The hernia sac was opened and 12 liters of ascites aspirated. Exploration of the sac’s cavity revealed the presence of part of the stomach and omentum, along with the small intestins and the tranverse and left colon. After reducing the herniated bowels, the intra-abdominal and intra-thoracic pressures were measured by the anesthesiologist, in order to estimate the amount of bowels to be resected, to achieve the appropriate level of pressures tolerated by the patient’s respiratory system. Subsequently, the left part of the transverse colon, along with the descending colon were resected to reach this adaptation. A terminal colostomy was created in the right abdominal quadrant. The hernia sac was resected and closed. A preperitoneal polypropylene mesh repair was performed (Figure 2).
Sex-Cord Tumor with Annular Tubules with Unusual Morphology in an Infant with Peutz-Jeghers Syndrome
Published in Fetal and Pediatric Pathology, 2022
Priyanka Maity, Nandini Das, Uttara Chatterjee, Dhananjay Basak
A five days old girl presented with signs and symptoms of intestinal obstruction and abdominal distension. CT scan showed gross distension of sigmoid colon and rectum with intraluminal filling defect (Fig. 1a). The baby was operated upon at six days of age. On laparotomy, the descending and sigmoid colon were obstructed by solid masses. The distended colon was excised and a proximal colostomy was constructed. We received 8 cm of resected colon, which on opening showed a large sessile polypoid mass measuring 5 cm across along with a several smaller polyps (Fig. 1b). On histopathological examination, the polyps showed arborization of muscularis mucosae within the lamina propria, giving rise to a Christmas tree appearance along with disorganization of glands, typical of Peutz Jegher polyp/hamartomatous polyp. There was no evidence of atypia (Fig. 1c and d).
Gastrointestinal injuries during gynaecologic operations at a university teaching hospital in Thailand: a 10-year review
Published in Journal of Obstetrics and Gynaecology, 2019
Nichaporn Sanguandeekul, Orawin Vallibhakara, Sakda Arj-Ong Vallibhakara, Areepan Sophonsritsuk
Table 2 shows the primary and delayed management of GI injuries for 102 and 2 cases that were detected intra- and post-operatively, respectively. There were 94 cases recognised during the peri-operative period, which underwent primary repair with successful outcomes. There was end-to-end anastomosis in 8 cases with GI injury detected intra-operatively and 1 case detected post operatively. Only one case of GI injury detected a post-operatively involved colostomy. Of all 104 cases of the GI injuries, a general surgeon was consulted in 95 cases (91.3%) after the detection or suspicion of GI injuries (data not shown). The time to diagnosis after the operation was 6–11 days (n = 2). Two cases that were diagnosed post-operatively presented with abdominal pain and fistula. The management methods were a supportive treatment and a colostomy for the small bowel and colon injuries, respectively.
Related Knowledge Centers
- Abdominal Wall
- Colorectal Cancer
- Stoma
- Surgery
- Large Intestine
- Surgical Incision
- Surgical Suture
- Ostomy System
- Feces
- Anus