Colostomy - Wikipedia

A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy ... Colostomy FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Surgicalprocedureinwhichaholeiscutintothecolonandstomaisplaced NottobeconfusedwithColonoscopy,Colotomy,orCorpuscallosotomy. ColostomyDiagramshowingacolostomyICD-9-CM46.1MeSHD003125MedlinePlus002942[editonWikidata] Acolostomyisanopening(stoma)inthelargeintestine(colon),orthesurgicalprocedurethatcreatesone.Theopeningisformedbydrawingthehealthyendofthecolonthroughanincisionintheanteriorabdominalwallandsuturingitintoplace.Thisopening,ofteninconjunctionwithanattachedostomysystem,providesanalternativechannelforfecestoleavethebody.Thusifthenaturalanusisunavailableforthatfunction(forexample,incaseswhereithasbeenremovedinthefightagainstcolorectalcancerorulcerativecolitis),anartificialanustakesover.Itmaybereversibleorirreversible,dependingonthecircumstances. Contents 1Uses 2Types 2.1Duration 2.2Alternatives 3Procedure 4Routinecare 4.1Colostomyandirrigation 5Complications 6References Uses[edit] Therearemanyreasonsforthisprocedure.Somecommonreasonsare: Apartofthecolonhasbeenremoved,e.g.duetocoloncancerrequiringatotalmesorectalexcision,diverticulitis,injury,etc.,sothatitisnolongerpossibleforfecestoexitviatheanus. Apartofthecolonhasbeenoperateduponandneedstobe'rested'untilitishealed.Inthiscase,thecolostomyisoftentemporaryandisusuallyreversedatalaterdate,leavingthepatientwithasmallscarinplaceofthestoma.Childrenundergoingsurgeryforextensivepelvictumorscommonlyaregivenacolostomyinpreparationforsurgerytoremovethetumor,followedbyreversalofthecolostomy. Fecalincontinencethatisnotresponsivetoothertreatments. Types[edit] Illustrationdepictingvarioustypesofcolostomy Typesofcolostomyinclude:[1][2] Loopcolostomy:Thistypeofcolostomyisusuallyusedinemergenciesandisatemporaryandlargestoma.Aloopofthebowelispulledoutontotheabdomenandheldinplacewithanexternaldevice.Thebowelisthensuturedtotheabdomenandtwoopeningsarecreatedintheonestoma:oneforstoolandtheotherformucus. Endcolostomy:Astomaiscreatedfromoneendofthebowel.Theotherportionoftheboweliseitherremovedorsewnshut(Hartmann'sprocedure). Doublebarrelcolostomy:Thebowelisseveredandbothendsarebroughtoutontotheabdomen.Onlytheproximalstomaisfunctioning.Mostoften,double-barrelcolostomyisatemporarycolostomywithtwoopeningsintothecolon(distalandproximal).Theeliminationoccursthroughtheproximalstoma. Colostomysurgerythatisplannedusuallyhasahigherrateoflong-termsuccessthansurgeryperformedinanemergencysituation.[citationneeded] Duration[edit] Acolostomymaybetemporary;andreversedatalaterdate;orpermanent. Alternatives[edit] AmanintheUKhasbeengivenaremote-controlledbowel.[3]Colostomyorileostomyisnowrarelyperformedforrectalcancer,withsurgeonsusuallypreferringprimaryresectionandinternalanastomosis,[4]e.g.anileo-analpouch.Inplaceofanexternalappliance,aninternalileo-analpouchisconstructedusingaportionofthepatient'slowerintestine,toactasanewrectumtoreplacetheremovedoriginal. Procedure[edit] Placementofthestomaontheabdomencanoccuratanylocationalongthecolon,butthemostcommonplacementisonthelowerleftsidenearthesigmoidwhereamajorityofcoloncancersoccur.Otherlocationsincludetheascending,transverse,anddescendingsectionsofthecolon.[5] Routinecare[edit] Seealso:Ostomysystem Pouchesandthestick-onappliancestowhichtheyattachmustbechangedregularly.Sometimesanodorneutralizerandlubricantissquirtedintoanewpouchbeforeitisattached.Twotypesofpouchesareavailable:onedisposableandonedrainable.Mostpouchesareopaqueandfilteroutairthroughacharcoalfilter.Therecommendedpracticeistoemptysuchpoucheswhenone-thirdfull.[6]Appliances,incontrastwithpouches,areusuallyreplacedeverythreetosevendaysexceptincaseswheretheirsealshavebrokencontactwiththeskin,whentheyshouldbereplacedimmediately.[6] Evenaslongagoasthe1940s,surgeonsconductingareviewattheClevelandClinic(JonesandKehm,1946)[7]couldsummarizetheroutinecareofthepermanentcolostomyasusuallyquitesatisfactory,statingthatafterpatientsrecoverfromtheinitialworrypromptedbytheneedforacolostomy,mostofthemlearntomanagetheircolostomyquitewell.[7]"Thesepatientscomefromallwalksoflifeandcarryontheirdailyworkasusual.Onepatientstatedthathecouldseenoadvantageofthenormalanusoveracolostomy.Whilethismaybesomewhatoverstated,itistruethatmostpeoplewithapermanentcolostomycanliveauseful,happylife."[7]Theyfoundthat,justasinanyoneelse,dietaryindiscretionwastheusualfactorinoccasionalbowelhabitdisruption.[7]Thishistoricalexperiencehasbeenborneout,astodaytheconclusionstillstandsthatmostpatientscansuccessfullymanageacolostomyaspartoftheiractivitiesofdailyliving. JonesandKehmpreferredtissuepaperasacolostomycover(heldinplacewithabandorgarment)ratherthanacolostomybag.[7]Theyfoundthatirrigationofthecolostomyvariedwitheachpatient'sbowelhabitbutthatmostpatientsdevelopedaroutineofevery-other-dayirrigation,whereasafewneedednoirrigation.[7] Peoplewithcolostomiesmustwearanostomypouchingsystemtocollectintestinalwaste.Ordinarily,thepouchmustbeemptiedorchangedacoupleoftimesadaydependingonthefrequencyofactivity;ingeneralthefurtherfromtheanus(i.e.,thefurther'up'theintestinaltract)theostomyislocatedthegreatertheoutputandmorefrequenttheneedtoemptyorchangethepouch.[8] Colostomyandirrigation[edit] Peoplewithcolostomieswhohaveostomiesofthesigmoidcolonordescendingcolonmayhavetheoptionofirrigation,whichallowsforthepersontonotwearapouch,butratherjustagauzecapoverthestoma,andtoscheduleirrigationfortimesthatareconvenient.[9]Toirrigate,acatheterisplacedinsidethestoma,andflushedwithwater,whichallowsthefecestocomeoutofthebodyintoanirrigationsleeve.[10]Mostcolostomatesirrigateonceadayoreveryotherday,thoughthisdependsontheperson,theirfoodintake,andtheirhealth. Complications[edit] Patientwithacolostomycomplicatedbyalargeparastomalhernia,whichiswhentissueprotrudesadjacenttothestomatract. CTscanofsamepatient,showingintestineswithinthehernia. Parastomalhernia(PH)isthemostcommonlatecomplicationofstomatathroughtheabdominalwall,occurringinabout48%ofthepatients.[11]Prolapseofbowelwallthroughthestomaoccasionallyhappensandcanrequirereoperationtorepair. Othercommoncomplicationsofcolostomyarehighoutput,skinirritation,prolapse,retraction,andischemia. References[edit] ^Potteretal.CanadianFundamentalsofNursing3rded.2006,ElsevierCanada.p1393-1394 ^"Archivedcopy".Archivedfromtheoriginalon2015-12-10.Retrieved2015-06-09.{{citeweb}}:CS1maint:archivedcopyastitle(link) ^Man-uses-remote-to-control-his-bionic-bottomTheTelegraph] ^al.],senioreditors,BruceG.Wolff...(2007).TheASCRStextbookofcolonandrectalsurgery.NewYork:Springer.p. 417.ISBN 978-0-387-24846-2.{{citebook}}:|first=hasgenericname(help) ^Potteretal.CanadianFundamentalsofNursing3rded.2006,ElsevierCanada.p1393 ^abTaylor,C.R.,Lillis,C.,LeMone,P.,Lynn,P.(2011)Fundamentalsofnursing:Theartandscienceofnursingcare.Philadelphia:LippincottWilliams&Wilkins,page1327. ^abcdefJones,ThomasE.;Kehm,RayW.(1946),"Managementofthepermanentcolostomy"(PDF),ClevelandClinicQuarterly,13(4):198–203,doi:10.3949/ccjm.13.4.198,PMID 20274022. ^"Colostomyirrigation:ColostomyGuide"(PDF).UnitedOstomyAssociationsofAmerica.Archivedfromtheoriginal(PDF)on23June2012.Retrieved4February2013. ^Rooney,Debra."Colostomyirrigation:Apersonalaccountmanagingcolostomy"(PDF).Ostomy.Retrieved7September2012. ^Wax,Arnold."Whatiscolostomyirrigation?".WebMed.Retrieved7September2012. ^PaulH.Sugarbaker(2013)."ParaostomyHernias:ProstheticMeshRepair".AbdominalSurgery.AmericanSocietyofAbdominalSurgeons.Archivedfromtheoriginalon2016-01-31.Retrieved2015-10-28. vteOstomysystemProcedures Colostomy Ileostomy Jejunostomy Ostomysystem Ostomybag vteTestsandproceduresinvolvingthedigestivesystemDigestivesystemsurgeryDigestivetractUpperGItractSGs/Esophagus Esophagectomy Hellermyotomy Sialography Impedance–pHmonitoring EsophagealpHmonitoring Esophagealmotilitystudy FunctionalLumenImagingProbe Highresolutionmanometry Stomach Sengstaken–Blakemoretube) Nasogastrictube Gastriclavage Bariatricsurgery Adjustablegastricband Endoscopicsleevegastroplasty Gastricbypasssurgery Sleevegastrectomy Verticalbandedgastroplastysurgery Collisgastroplasty Gastrectomy BillrothI BillrothII Roux-en-Y Gastroenterostomy Gastropexy Gastrostomy Percutaneousendoscopicgastrostomy Esophagogastricdissociation Hillrepair Nissenfundoplication Pyloromyotomy Schillingtest Medicalimaging Endoscopy Esophagogastroduodenoscopy Bariumswallow Uppergastrointestinalseries LowerGItractSmallbowel Bariatricsurgery Duodenalswitch Jejunoilealbypass Bowelresection Ileostomy Intestinetransplantation Jejunostomy Partialilealbypasssurgery Strictureplasty Largebowel Appendectomy Colectomy Colonicpolypectomy Colostomy Hartmann'soperation Rectum Abdominoperinealresection Loweranteriorresection Totalmesorectalexcision Analcanal Analsphincterotomy Anorectalmanometry Lateralinternalsphincterotomy Rubberbandligation Transanalhemorrhoidaldearterialization Medicalimaging Endoscopy:Colonoscopy Anoscopy Capsuleendoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominalultrasonography Defecography Double-contrastbariumenema Endoanalultrasound Enteroclysis Lowergastrointestinalseries Small-bowelfollow-through Transrectalultrasonography Virtualcolonoscopy Stooltests Fecalfattest FecalpHtest Stoolguaiactest AccessoryLiver Artificialextracorporealliversupport Bioartificialliverdevices Liverdialysis Hepatectomy Liverbiopsy Livertransplantation Portalhypertension Transjugularintrahepaticportosystemicshunt[TIPS] Distalsplenorenalshuntprocedure Gallbladder,bileduct Cholecystectomy Cholecystostomy ERCP Hepatoportoenterostomy Medicalimaging:Cholangiography IV MRCP PTC Cholecystography Cholescintigraphy Pancreas Frey'sprocedure Pancreastransplantation Pancreatectomy Pancreaticoduodenectomy Puestowprocedure AbdominopelvicPeritoneum Diagnosticperitoneallavage Intraperitonealinjection Laparoscopy Omentopexy Paracentesis Peritonealdialysis Hernia Herniarepair Inguinalherniasurgery Femoralherniarepair Other Laparotomy Exploratorylaparotomy Rapidureasetest/Ureabreathtest Clinicalpredictionrules MELD PELD UKELD Child–Pughscore Ransoncriteria Milancriteria Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Colostomy&oldid=1064933507" Categories:DigestivesystemsurgeryHiddencategories:CS1maint:archivedcopyastitleCS1errors:genericnameArticleswithshortdescriptionShortdescriptionmatchesWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromJuly2007 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages العربيةCatalàČeštinaΕλληνικάEspañolEuskaraفارسیFrançais한국어ItalianoNederlandsNorskbokmålPolskiPortuguêsSvenska Editlinks