Colon, rectum and anus
Michael Gaunt, Tjun Tang, Stewart Walsh in General Surgery Outpatient Decisions, 2018
A stoma is a surgically constructed opening of the bowel (or urinary system) on to the skin of the abdomen. Stomas can be permanent or temporary. The aim with temporary stomas is to restore bowel continuity at a later date. End stomas are usually permanent and are one end of the bowel sutured to the skin. Loop stomas are usually temporary, where a loop of bowel is brought through the abdominal wall and the anterior wall is opened so that two orifices, proximal and distal, are visible, but only the proximal end discharges. Over time the distal orifice may shrink so that it is barely visible. The double-barrelled stoma is similar, except that two ends of bowel are brought out together, usually after the segment of bowel between has been resected. Double-barrelled stomas are usually temporary.
Stoma Management in the Acute Abdomen
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 in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Creation of an intestinal stoma is a common surgical procedure performed with the simple goal of allowing an intestinal fluid egress from the body. Approximately 100,000 patients in the United States undergo an operation every year that results in the creation of an ileostomy or colostomy. There are a wide variety of clinical situations requiring a stoma.1 Ostomies may be created to provide faecal diversion or performed in conjunction with more radical procedures. Stomas may be created using open or minimally invasive techniques. Stomas are created for benign or malignant diseases. They may be performed electively or as an emergency in an unstable patient. Stomas may be temporary or permanent. Too often, the creation of a stoma is an afterthought at the end of a difficult case and may not be given the attention it deserves. The importance to the patient of performing the procedure well cannot be overstated because of the enormous impact a poorly constructed stoma or stomal complications may have on a patient’s quality of life. As with many complex surgical problems, optimal treatment of stomal complications often requires a team approach, employing colorectal or general surgeons, gastroenterologists, occasionally plastic surgeons and, most importantly, nurses adequately trained in the care of an intestinal stoma.
Ostomy, Fistula, and Skin Management
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
Minor complications are reported in 13–40% of patients with a percutaneous gastrostomy tube [19]. The most common complications of the stoma site include peristomal skin irritation/breakdown, leaking, bleeding, hypergranulation tissue growth, and infection at the stoma site. General care of the tube site includes daily assessment for skin problems and gentle washing under the retention bumper with mild soap and water using cotton-tipped applicators. Hydrogen peroxide, rubbing alcohol, and/or routine/prophylactic use of topical antibiotic ointments/creams is not recommended as these can contribute to peristomal skin problems. The skin should be examined for excess moisture, denudation from leakage, rashes, nonblanchable erythema from too much pressure applied by the external bolster (i.e., too tight against the skin), skin stripping from adhesives and/or increased warmth, redness, or purulent drainage from infection. The retention bumper and flange should not be moved or “slid up and down” the tube during care as this can contribute to bumper failure over time. During examination, the edges of the retention bumper should be gently lifted on all sides to access and assess the tube insertion site. The site will be at increased risk for complications if it is located in a skin crease, fold, or scar and when the patient is obese or immunocompromised (e.g., diabetes mellitus, posttransplant, immunosuppressant medications) [19–21].
Physical activity and nutritional interventions and health-related quality of life in colorectal cancer survivors: a review
Published in Expert Review of Quality of Life in Cancer Care, 2018
Luisa Soares-Miranda, Sandra Abreu, Ana Ruiz-Casado, Alejandro Lucia
An ostomy (also commonly called a stoma) is a small surgically created opening on the surface of the abdomen to divert the flow of feces, which is sometimes necessary after bowel surgery. Ostomies can be temporary or permanent, and can be reversed within a very variable time frame. Ostomies also depend on the type and site in the bowel (ileostomy or colostomy), and how they were created (end vs. loop stoma). Loop stomas are usually intended to be temporary. Stomas are much more frequent in rectal cancer than in colon cancer; approximately 42% of rectal cancer cases will have a stoma appliance, and up to 90% of these cases can have a stoma reversed [25]. Cancer survivors with a stoma may need more specific support. Unfortunately, health practitioners and cancer survivors have poor knowledge about recommended activities and more research is clearly needed [26].
Constipation, ileus and medication use during clozapine treatment in patients with schizophrenia in Iceland
Published in Nordic Journal of Psychiatry, 2018
Oddur Ingimarsson, James H. MacCabe, Engilbert Sigurdsson
The mean observational period during clozapine treatment for the 188 patients ever on clozapine was 8.9 years (SD = 5.8) with an interquartile range of 11.5 and a median time of 9.3 years. The mean age at the end of follow-up was 51.2 years (SD = 11.9). Four patients out of 188 (2.1%) were diagnosed with ileus with no tumor detected. The estimated ileus incidence rate was therefore 2.4 cases per 1000 person years. Two of the four patients developing ileus required ileostomy surgery that resulted in a permanent stoma. The mean time from the onset of clozapine treatment to ileus was 13.7 years (15.3, 8.7, 17.6 and 13.3 respectively). The mean age at the time of ileus was 50.6 years (47.4, 54.4, 66.5 and 34.0). No fatalities were associated with ileus. Three out of these four patients continued on clozapine treatment after being diagnosed with ileus while one patient discontinued clozapine treatment shortly after developing ileus but this patient recommenced the clozapine treatment half a year later.
Long-term results of continent catheterizable urinary channels in adults with non-neurogenic or neurogenic lower urinary tract dysfunction
Published in Scandinavian Journal of Urology, 2019
Ilse M. Groenendijk, Joop van den Hoek, Bertil F. M. Blok, Rien J. M. Nijman, Jeroen R. Scheepe
After obtaining approval by the local ethics committee (MEC-2017-354), all patients who were still using the channel by the end of December 2017 were sent a 5-item questionnaire. The first question was the global impression of improvement (PGI-I instrument). (1) The PGI-I is a single question to rate the urinary tract condition now, as compared to before beginning treatment (construction of the CCUC) on a scale from 1: Very much better, to 7: Very much worse. The other questions were addressing (2) continence of the stoma (completely dry/some leakage, one pad is enough/leakage with need for a stomal bag/stoma is completely incontinent/catheter in stoma), (3) urethral leakage (did you have any urethral incontinence in the last 2 weeks? Yes/No), (4) difficulty with catheterization (always easy/most of the time easy, sometimes not easy or painful/always problematic or painful), and (5) willingness to recommend this procedure to others with a comparable condition.