What Is a Continent Ileostomy?

Ileostomy is suitable for colon injury or colon perforation. Making a temporary ileostomy after repairing a colonic lesion will allow the colon to be fully rested, ensure a smooth recovery of colonic lesions, and reduce the incidence of colonic fistulas.

Ileostomy

Right!

Ileostomy is suitable for colon injury or colon perforation. Making a temporary ileostomy after repairing a colonic lesion will allow the colon to be fully rested, ensure a smooth recovery of colonic lesions, and reduce the incidence of colonic fistulas.

Ileostomy

Pediatric surgery / Small intestine colostomy / Small intestine

46.2001

The small intestine is an important digestive organ. The duodenum is from the pylorus to the kyphotic ligament, and the jejunum and ileum from the kylid to the ileocecal valve. The length of the small intestine varies with age, and there are considerable individual differences. The mesentery of the jejunum and ileum are attached to the posterior abdominal wall, starting from the left side of the second lumbar vertebra and ending in front of the sacroiliac joint. The jejunum accounts for about 40% of the small intestine and 60% of the ileum. There is no clear boundary between the two. Generally speaking, the jejunum has a larger diameter and thicker intestinal wall. The jejunal mesentery has only one layer of vascular arch. The ileum intestinal wall is thin and thin. This procedure can be used to determine the approximate location of the small intestine.

The main physiological function of the small intestine is to digest and absorb nutrients, and the small intestine fluid contains a variety of enzymes. After the small intestine stoma, it is easy to cause digestive and absorption disorders and water and electrolyte disorders, causing dehydration in sick children. Excessive intestine exposure can cause severe malnutrition. Therefore, the small intestine ostomy should strictly grasp the indications. Once the sick child's condition allows, the stoma should be closed as soon as possible to reduce complications.

Ileostomy is suitable for:

1.

2. Some diseases require permanent small intestine ostomy, such as ulcerative colitis and familial colonic polyposis, and a total colectomy is required. Permanent ileostomy can be done selectively.

Due to the different conditions of patients with small intestine stoma, preoperative preparations are also different. However, most patients are admitted to the emergency department and are in critical condition, often with water and electrolyte disorders, or even shock. Therefore, all preparations should be made before the operation and the operation should be performed as soon as possible without delaying the disease.

1. When combined with toxic shock, anti-shock treatment should be immediately performed, while rescue, preparation for surgery.

2. Immediately check the hematuria routine and blood biochemical tests, such as potassium, sodium, chlorine, carbon dioxide binding carbon binding capacity, urea nitrogen, blood gas analysis, hematocrit, and understand the degree of blood concentration and the degree of water and electrolyte imbalance. Develop preliminary rehydration measures and plans.

3. Immediately open the venous channel. When severe shock occurs, venous incision can be performed, and rapid infusion is performed to quickly improve dehydration and acidosis. Transfusion or plasma if necessary to increase colloid osmotic pressure.

4. Place gastric tube for gastrointestinal decompression. Supplement vitamin B1, vitamin C, and vitamin K.

5. Apply antibiotics.

General anesthesia endotracheal intubation is preferred. Spinal canal anesthesia or epidural anesthesia can lower blood pressure and are not safe enough. The critically ill patients can use basic anesthesia plus procaine local infiltration anesthesia. Posture: Preferable supine position.

1. Incision in the lower abdomen arc or incision in the right lower abdomen.

2. Put the distal ileum 10cm away from the ileocecal valve outside the incision, separate the corresponding mesentery, and cut off and ligate the mesentery blood vessels to the mesentery root. Care should be taken to preserve blood flow at both ends of the intestine.

Use Kocher forceps to clamp the two ends of the intestinal canal, cut off the intestinal canal, wipe the stump with an ethanol gauze ball, and do two-layer purse suture on the distal intestinal canal. Make an oblique incision at the outer edge of the rectus abdominis muscle 2 to 3 cm long, cut the external oblique tendon of the abdomen, cut off the oblique and transverse abdominal muscles, and cut the peritoneum. The proximal bowel was raised approximately 4 cm outside the incision. The intestinal serosa and muscle layer is intermittently sutured with the peritoneum, fascia, and skin to prevent the stoma and bowel from retracting or other intestines to hernia through this incision.

The stoma was temporarily closed and reopened 48 to 72 hours after surgery to reduce contamination of the incision. However, some authors claim that the stoma can be opened during the operation. In addition to reducing the internal pressure of the ileum, the newly formed stoma has a good appearance, fast healing, and less local scar tissue, which can reduce the complications of the stoma.

After ileostomy, do the following:

1. The catheter should be properly fixed to prevent it from falling off and keep the catheter open.

2. Postoperative gastrointestinal decompression, after gastric bowel movement recovered, remove gastric tube.

3. Maintain water and electrolyte balance: After the intestinal peristalsis is restored, the small intestine stoma can expel a large amount of intestinal fluid, which easily causes water and electrolyte balance disorders. At this time, the loss should be accurately estimated and supplemented according to the principle of fluid replacement. After 1 to 2 weeks, the intestinal absorption increases, the intestinal fluid discharge gradually decreases, and the stool becomes thicker. At this time, it is easier to maintain the water-electrolyte balance.

4. Properly protect the skin around the stoma to prevent erosion. Because the small intestine contains a variety of digestive enzymes, it is easier to erode the skin and cause erosion, and ulcers will form over time. It can be protected with a protective film in the early stage, or coated on the skin with medical glue. If the skin has been eroded, it can be protected by zinc oxide and methyl violet paste. The intestinal lumen draws intestinal fluid to reduce its contact with the skin. Severe skin erosion can be baked with a baking lamp.

5. Keep the catheter clean, small intestine stoma for perfusion nutrition, glucose solution or mixed milk can be dripped from the catheter 2 to 3 days after surgery.

6. After each food infusion, the pipes should be flushed with water to prevent the food from spoiling in the catheter. The next infusion will enter the intestine with the food and cause enteritis.

7. After the condition is improved, the stoma should be closed as early as possible to avoid long-term loss of intestinal fluid, especially the high intestinal stoma.

The time to close the stoma is generally 3 to 4 weeks after surgery. At this time, the general condition of the sick child improves, the nutritional status improves, hemoglobin rebounds, water and electrolyte disorders have been corrected, and the distal bowel is unobstructed, and there is no infection in the abdominal cavity. Stoma closure can be performed when the skin is not severely eroded.

The preventive methods are: children with high-risk diseases who are likely to have a dehiscence after surgery should be given suture reduction during surgery; actively strengthen supportive therapies, including the input of protein, plasma, and whole blood, and at the same time as early as possible infusion of nutrients and Other high-calorie, high-vitamin diets; use effective antibiotics to prevent infection of the abdominal cavity and incision; keep the gastric tube open after surgery to reduce abdominal distension; maintain water and electrolyte balance to promote incision healing.

2. Ileostomy 2. Prostoma of the stoma

The preventive method is that the piercing hole of the abdominal wall fascia layer through which the stoma bowel passes should not be too large; the stoma bowel wall muscularis layer should be properly sutured with the peritoneal layer, fascia and skin.

3. Ileostomy 3. narrow stoma

Caused by contracture of stoma scar tissue. Prevention: The stoma should not be too tight or too small, and it should be expanded 2 weeks after the operation.

4. Ileostomy

Because the small intestine is short, it is caused by continuous stretch after operation. Another reason is that the bowel remains too short outside the abdominal wall. After the bowel is retracted, the abdominal wall should be re-operatively pulled out and properly fixed.

5. Ileostomy 5. intestinal obstruction

It is more commonly caused by compression of the intestinal tube after the adhesion of the intestine, and sometimes the intestinal tube is twisted with the stoma intestine as the axis. Once the obstruction occurs, the obstruction should be removed in time.