ileostomy.pptx dr. atul khare

examination

1. ILEOSTOMY CASE PRESENTATION DR.ANKUSH LOKHANDE

2. Patient’s Information Name: Mr.X Age : 30years Gender: Male Occupation: Farmer Address : Damoh

3. CHIEF COMPLAINTS Patient came to OPD for follow up for stoma closure. c/o redness and itching in skin around stoma since 2 weeks.

4. HISTORY OF PRESENTING ILLNESS Patient was apparently well 2 months back when he was admitted to NSCB MCH, Jabalpur with complaints of acute abdominal pain & vomitting and was found to have perforation peritonitis for which emergency exploratory laparotomy was done and stoma was created. At present stoma is well functioning with daily output of about 500ml of semisolid faeces. Patient complains of redness and itching over skin around stoma ,which was insidious in onset , developed after the stoma bag was accidentally removed 2 weeks back.Initially it progressed for few days and then gradually starts subsiding after topical application of ointment.

5. Continued…. No c/o abdominal pain, distension and vomitting. No c/o pain and bulging at stoma site. No c/o bleeding from stoma. No c/o change in colour of stoma. No c/o altered stoma output. No c/o excessive thirst or dryness of mouth. No c/o protrusion or retraction of stoma on change of posture.

6. Local Examination INSPECTION An exteriorised loop of bowel of size 4*3 cm with two visible openings in right iliac fossa present , 4cm lateral to umbilicus, on spino-umbilical line. Stoma is protruding 2.5 cm above skin surface. Visible peristalsis present with Semisolid effluent is coming out from upper opening. Mucosa is pink and healthy with circular folds. Skin around the stoma near proximal opening is excoriated. Rest of the surrounding skin is smooth, healthy and dry. No peristomal sinuses, bulging or discharge seen. No prolapse, retraction or visible cough impulse seen. A vertical linear scar mark of size 12 cm of previous exploratory laparotomy present in midline on both sides of umbilicus.

7. Examination …. PALPATION No local rise of temperature,no tenderness. Loop stoma of size 4*3 cm with two openings in right iliac fossa , 4cm lateral to umbilicus, on spino-umbilical line. Stoma is protruding 2.5 cm above skin surface.Mucosa is smooth , healthy and dry . Both openings allow introduction of index finger easily. Soft ,semisolid, green coloured faecal matter present in upper opening of stoma. No stenosis,no growth, no bleeding present on digital examination of both openings. Skin around the stoma near proximal opening is excoriated with healthy granulation tissue present.Rest of the surrounding skin is smooth, healthy and dry. No cough impulse , no peristomal hernia present. Abdomen is soft, non-tender with a vertical scar mark of size 12 cm present in midline on both sides of umbilicus.The scar mark is healthy and non-tender.

8. Diagnosis My provisional diagnosis is temporary diverting loop ileostomy in right iliac fossa with peristomal excoriation.

9. THANKYOU