NMS. Casos Clínicos

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Part II ♦ Specific Disorders

A B Figure 8-47: Performance of ileostomy. A: Ileum being sewn to the skin. B: After completion of the ileostomy. (From Greenfield LJ, Mulholland MW, Oldham KT, et al., eds. Surgery: Scientific Principles and Practice , 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1997:1100.)

are created to divert the fecal stream while either healing of an anastomosis occurs or an inflammatory process related to GI leakage subsides. Pairs of end stomas that act as single openings (“double barrel” stomas) or loops that are brought up onto the abdominal wall and opened are temporary stomas. Loop stomas are not totally diverting and must be separated like double barrel stomas for complete diversion. Distal bowel stomas are termed “mucous fistulas” because their only contents are mucosal-derived mucus and no stool. If the distal colon is closed and not brought to the abdominal wall but rather dropped back into the pelvis, it is termed a “Hartmann pouch.” This is commonly done for sigmoid resections for diverticulitis when the bowel cannot be safely reconnected. Loop stomas, cecostomies, and tube cecostomies can also be performed to decompress a distended segment of bowel temporarily, as in Ogilvie syndrome. Permanent stomas are most commonly used in the following situations (presented in order of decreasing frequency): ◆ ◆ Following an abdominoperineal resection in which an end sigmoid colostomy is created ◆ ◆ An ileostomy following total proctocolectomy for ulcerative colitis if a pouch fails or cannot be done or the patient prefers an ileostomy ◆ ◆ An ileal conduit draining the urinary system to the skin Because the output from ileostomies is particularly irritating to the skin, ileostomies are designed to result in continence or protrude from the skin so that their output drops directly into the appliance (in the same manner as a spigot). Carefully applied appliances are critical to the success of ileostomies. CUT TO TEXTBOOK For more information, see Chapters 13 and 14. SAMPLE