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.
Yasmin’s story
Viv Martin, Karen Forbes in Developing a Narrative Approach to Healthcare Research, 2018
Yasmin is in her 40s and has had Crohn’s disease, a form of inflammatory bowel disease (IBD), for 15 years.1,2 She has had many bowel operations, including a temporary colostomy and a permanent ileostomy. The siting of the ileostomy has been problematic; high output and consistency of waste through the stoma (the opening in the body where the bag is fitted) has meant that it is very difficult to manage. The nature of Yasmin’s condition is unpredictable: the bag needs emptying frequently and therefore she has a loss of control over getting rid of waste. Her illness affects her whole body system; it unbalances her body chemistry and causes dehydration. She has had serious infections including peritonitis and septicaemia and has been in intensive care on several occasions. She has to have blood tests every week, and has needed frequent hospitalisation to the degree that this illness has taken over her life and disrupted most of what was her previous life.
Pull-through procedure for Hirschsprung disease: Case study
Victoria A. Lane, Richard J. Wood, Carlos A. Reck-Burneo, Marc A. Levitt in Pediatric Colorectal and Pelvic Surgery, 2017
At this point, the surgeons proceeded with a laparoscopic-assisted pull-through as the child was clinically well. Due to concern of turbid fluid, enterocolitis was suspected. Therefore,The bowel was mapped with multiple full-thickness colonic biopsies in order to identify the normal ganglionated bowel and to aid in the preoperative planning for the definitive pull-through procedure. An ileostomy was performed.The frozen section biopsies are shown in Table 40.1.
The rectal remnant after total colectomy for colitis – intra-operative,post-operative and longer-term considerations
Published in Scandinavian Journal of Gastroenterology, 2018
Kalle Landerholm, Christopher Wood, Alexander Bloemendaal, Nicolas Buchs, Bruce George, Richard Guy
Strictly speaking not a mucus fistula at all, but a closed rectal remnant secured in a convenient position, this method eliminates the need for a second stoma whilst retaining some control over the stump. The remnant is sutured or stapled closed (or both) and exteriorised outside the peritoneal cavity in the subcutaneous tissues, usually in the lower part of the midline wound, suturing it to the fascia [13,15,16]. An alternative location is adjacent to the ileostomy. If the stump dehisces in these positions the closed fistula is hopefully converted to an open mucus fistula over which some control is obtained. Whilst pelvic sepsis is usually avoided if dehiscence occurs extraperitoneally, there is a risk of wound complications reported in up to 35% [12,13,16–18], with the potential for developing necrotising sepsis [13].
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.
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.
Related Knowledge Centers
- Stoma
- Small Intestine
- Ileum
- Ostomy System
- Groin
- Abdomen
- Large Intestine
- Rectum
- Crohn's Disease
- Ulcerative Colitis