A slide on Colostomy care and management

A good slide

1. Colostomy P . M. Mshelbwala Department of Surgery College of Health Sciences University of Abuja

2. Colostomy - objectives To classify colostomy To determine indications for colostomy To understand colostomy care and complications P.M. Mshelbwala University of Abuja

3. Colostomy - Outline Introduction Indications Classification Surgical considerations Colostomy care Complications Colostomy reversal P.M. Mshelbwala University of Abuja

4. Colostomy - introduction A surgically constructed opening between the colon and the skin of the anterior abdominal wall An artificial colo-cutaneous fistula Diverts faeces and flatus to the exterior Performed in adults and children Performed in emergency or elective situations Other parts of the GIT can also be used for stoma creation P.M. Mshelbwala University of Abuja

5. Colostomy - indications Based on: Disease conditions Function of colostomy P.M. Mshelbwala University of Abuja

6. Colostomy - indications Based on diseases Congenital Anorectal malformation (ARM), Hirschsprung’s disease, spina bifida with incontinence, cloacal exstrophy , colonic atresia Acquired Rectal & perineal injuries, obstruction ano -rectal malignancies, ano -rectal inflammatory diseases ( lympho-granuloma venereum (LGV), fistila -in- ano ), acquired recto-vaginal fistula P.M. Mshelbwala University of Abuja

7. Colostomy - indications Based on function colostomy will serve 1. To divert from a distal obstruction ARM, Hirschsprung’s disease, ano -rectal carcinoma 2. To protect a distal anastomosis Following PSARP, Pull-through operation 3. To allow healing of distal injuries Rectal & perineal trauma 4. To allow healing of distal inflammatory conditions LGV, fistula-in- ano 5. Due to loss of faecal incontinence Spina bifida, post surgery for ano -rectal carcinoma Some indications may overlap P.M. Mshelbwala University of Abuja

8. Colostomy - classification Based on: Duration Anatomy of colon Surgical technique P.M. Mshelbwala University of Abuja

9. Colostomy - classification Based on duration Temporary colostomy Plan is to reverse when its function has been accomplished e.g. rectal injuries, ARM Common in children Permanent colostomy Will be in place for life Ano -rectal carcinoma, non-functional anal sphincters e.g. spina bifida with incontinence P.M. Mshelbwala University of Abuja

10. Colostomy - classification Based on anatomy Part of colon with long mesentery that will allow easy mobilization to the skin Transverse colostomy usually right transverse colon brought out on right hypochondrium Sigmoid colostomy brought out in left iliac fossa P.M. Mshelbwala University of Abuja

11. Colostomy - classification Based on surgical technique used Loop colostomy Maintains colonic continuity on the mesenteric surface Divided colostomy Complete transection of the colonic circumference Either double barrel or Devine End (Terminal) colostomy Only one end (proximal) brought to exterior Almost always used for permanent colostomies P.M. Mshelbwala University of Abuja

12. Sigmoid loop colostomy P.M. Mshelbwala University of Abuja

13. Sigmoid colostomy Double barrel: stoma placed side by side Devine: Skin bridge placed in between stoma P.M. Mshelbwala University of Abuja

14. Colostomy - surgical considerations Consider duration it will be in place Mark site pre-operatively Consider site of future incisions Ensure easy access For patient Allow for attachment of collecting appliances/bags Avoid belt line Avoid bony prominences P.M. Mshelbwala University of Abuja

15. Colostomy care Commences even before construction With patient counseling Plan for colostomy devices Local or commercial Skin care with barrier cream Psychological support Colostomy training Especially for permanent colostomy P.M. Mshelbwala University of Abuja

16. Colostomy - complications Early Haemorrhage Necrosis Dehiscence Surgical site infection Diarrhoea osmotic Late Skin excoriation Retraction Prolapse Stenosis Hernia Parastoma or internal Diahrrhoea infective P.M. Mshelbwala University of Abuja

17. Colostomy complications P.M. Mshelbwala University of Abuja

18. Colostomy – reversal when indication for stoma has been treated Bowel preparation To reduce bacterial load in colon Contrast studies may be indicated To ensure resolution of primary condition Types: Extra-peritoneal Intra-peritoneal Complications Surgical site infection Peritonitis Anastomotic leakage Enterocuatenous fistula Intestinal obstruction due to adhesions or stenosis Scars on abdominal wall P.M. Mshelbwala University of Abuja

19. Colostomy - objectives To classify colostomy To determine indications for colostomy To understand colostomy care and complications P.M. Mshelbwala University of Abuja

20. References Principles & Practice of Surgery including pathology in the tropics. 4 th edition. Badoe , Archamapong , da Rocha- Afodu Paediatric Surgery Specialty and its Relevance to Africa Paediatric Surgery: A Comprehensive Text for Africa. Eds : Ameh EA, Bickler SW, Lakhoo K, Nwomeh BC, Poenaru D.Global Help Publications 2010 Ashcraft’s pediatric surgery / Eds. G. W. Holcomb III, J. P. Murphy ; assoc Ed, D. J. Ostlie . — 5th ed. P.M. Mshelbwala University of Abuja