stomas l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Stomas PowerPoint Presentation
Download Presentation
Stomas

Loading in 2 Seconds...

play fullscreen
1 / 27

Stomas - PowerPoint PPT Presentation


  • 499 Views
  • Uploaded on

Stomas. Bruce D George John Radcliffe Hospital. Permanent temporary Colostomy ileostomy End loop Functional mucus fistula Incontinent continent GI urostomy. Classification of Stomas. Anal sphincter failure

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Stomas' - zoe


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
stomas

Stomas

Bruce D George

John Radcliffe Hospital

classification of stomas
Permanent temporary

Colostomy ileostomy

End loop

Functional mucus fistula

Incontinent continent

GI urostomy

Classification of Stomas
indications for stoma formation
Anal sphincter failure

To “protect” distal anastomosis or when anastomosis not appropriate

To reduce disease activity distally

Indications for Stoma Formation
anal sphincter failure
Congenital anorectal atresia

Surgical removal

APER

proctocolectomy

Destruction by disease

Tumour

Crohn’s

Severe incontinence

Anal Sphincter Failure
slide5
Post anterior resection

Post ileal pouch anal anastomosis

Perforated sigmoid diverticulitis

Acute fulminant colitis

To “protect” distal anastomosis:

Anastomosis not appropriate:

to reduce disease activity distally
To reduce disease activity distally
  • Severe Crohn’s colitis
  • Severe perianal Crohn’s disease
stoma management
Pre-operative

Operative

Post-operative

Stoma management
pre operative management
Pre-operative management
  • Psychological preparation
    • Do not frighten inappropriately
  • Mark site
    • Avoid scars, skin folds, bony prominences
  • Consider ability to manage stoma
    • Brain, eye or hand failure
surgical technique
Consider stoma formation to be like an anastomosis between bowel and skin

Healing depends on:

Good blood supply

No tension

General healing ability

Surgical technique
slide14

End ileostomy

End colostomy

complications of stoma formation
Complications of Stoma formation

If anything can go wrong it will

Captain Edward Murphy 1949

early complications
Early complications
  • Psychological
early complications17
Early complications
  • Initial oedema

Necrosis

Test-tube test at bedside

early complications18
Stoma not working

Ileus

Small bowel obstruction

Obstruction at abdominal wall

Retraction

Working too much

High output

Leaking

Poor siting

Muco-cutaneous separation

Early complications
intermediate or late complications
Stenosis

Prolapse

Parastomal herniation

Intermediate or late complications
summary
Pre-operative care

multidisciplinary

Meticulous operative technique

like an anastomosis between bowel and skin

Post-operative care

multidisciplinary

Summary