BARSAK STOMALARI. Doç.Dr.Tamer AKÇA. K olostomi. Kalın barsağın anüsün tüm veya bir kısım görevlerini görmek üzere, anüsten bir başka yerden deriye açılmasıdır (anus contre nature, anus artificiél). Amaç. Tıkanmış ve gerilmiş kolonu basınçtan kurtarmak
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The night café1888; Yale University Art Gallery
An 84-year-old man presented with obstipation and abdominal distention. Flat plate showed distended small and large bowel. Flexible sigmoidoscopy to 25 cm was unremarkable. Passage of a colonoscope beyond a redundant sigmoid loop revealed the lesion shown. The lesion was biopsied.
The anesthesiologist was alerted to possible drop in pressure on opening the abdomen. Release of intraabdominal compression by distended bowel loops decreases venous return to the heart, compounding the contracted intravascular volume due to third space loss, and the hypotensive effects of anesthesia. Distended bowel loops were released slowly under control, and despite several liters of pre-op resuscitation, there was still a pressure drop requiring an additional 10 liters of fluid over the course of the procedure.
A mass was palpable at the junction of descending and sigmoid colon, with serosal dimpling and traction on the parietal peritoneum into the center of the mass.
The Peritoneal reflection (white line of Toldt, see total colectomy) was opened proximal and distal to the lesion.
Peritoneum was opened and the opening dilated to three finger breadths. The opening size was gauged to allow comfortable fit and function of the colon while minimizing the chance of herniation.
The bowel wall was sutured to the deep fascia from the skin side using 3-0 silk
The stoma was matured full thickness of bowel to dermis using 4-0 absorbable suture
Vincent's Room, Arles1888; Vincent Van Gogh Foundation, Amsterdam